(Active Members and Non-Medicare Retirees)

NC HealthSmart helps members reach their health and wellness goals each day.  Phyllis, a member from Elizabeth City, was admitted to the hospital for congestive heart failure and pneumonia.  After being discharged, Phyllis opted for in-home care with her husband, rather than an inpatient facility. 

Phyllis and her husband ran into a number of challenges once they were home. They declined a scheduled home health nurse visit because they believed that they would have to pay a copay. Phyllis had difficulties getting around her home, which resulted in a fall and a call to EMS for assistance. In addition, Phyllis was unable to get to their car to attend her follow-up appointments with her Primary Care Provider (PCP), which resulted in Phyllis also not receiving much needed nebulizer treatments because they had not been authorized by her provider.

An NC HealthSmart Nurse Case Manager reached out to Phyllis to get a better understanding of the challenges she had been facing and figure out a way to help. After hearing her story, the Case Manager held a conference call with Phyllis’ husband and the State Health Plan to better explain how home health benefits and payments worked and inform them that they would not need to pay an out-of-pocket copay for each home health visit.

After that conversation, Phyllis and her husband accepted the return of the home health nurse for treatment.  The Case Manager also arranged to have the home health nurse relay her condition status and medication list to Phyllis’ PCP in lieu of a personal visit. The Case Manger then assisted Phyllis’ husband in coordinating with the discharging physician to order nebulizer treatments and home physical therapy.  Phyllis’ husband also agreed to call his pastor to seek assistance in building a ramp at their home and was put in touch with someone who could build the ramp in January.

Phyllis is now able to move around more easily and get back and forth to their car for provider appointments.  With the help of a Case Manager, Phyllis was able to realize her goal of recovery at home rather than in an inpatient facility.

For more information about NC HealthSmart services and supports that are available to you, please visit  NC HealthSmart page or call 800-817-7044.