the news that the doctor himself was being treated in hospital for a pulmonary embolism, but that he would resolve all queries once he had been discharged from hospital. TAA’s assessment doctor decided to contact the patient’s family doctor in his home country and the case manager also tried to establish contact with this doctor through the patient’s son. Te son eventually understood the importance of this request and reluctantly provided these contact details.

A different picture After the conversation between TAA’s assessment doctor and the family doctor in his home country, a different picture began to emerge regarding the patient’s medical situation. It transpired that the patient travelled on short trips quite regularly. His COPD III was manageable with a permanent oxygen supply. Te paralysis of the left side of his body was as a result of two heart attacks that he had suffered in 2015. Furthermore, he has suffered from incontinence for years, a side effect of his medication. Without sufficient and reliable information concerning the patient’s medical situation, TAA’s assessment doctor again had to postpone a decision on his repatriation. TAA’s case manager was asked to contact the hospital directly in order to gather information, as the patient’s family was not willing or able to provide current medical information. Both the insurance company and the patient’s son were kept updated on the situation. Te son disagreed strongly with this further delay, and staff in the Medical Assistance centre were confronted by a frustrated family member who did not accept this decision. Te patient’s son was informed that any steps taken or travel arrangements made by himself would be done at his own risk and at his own expense. Te Medical Assistance centre proceeded with work on the case, despite being threatened with legal action by the patient’s son. Not for the first time, TAA’s case manager was confronted with such statements as ‘you all are incompetent’ and ‘the insurance company just wants to save money’. Te next step taken by TAA was to contact the patient’s family doctor in South Africa with

the information they had received from the patient’s family doctor in his home country. Te South African doctor explained that the patient’s son was a very well respected figure in South Africa, and that he had therefore believed the son’s statements about his father to be accurate. Furthermore, the family doctor in South Africa said that he had confirmed the patient’s fitness to travel. He apologised and promised to request the medical report from the hospital directly and to forward it to TAA; it eventually arrived three days later.

Tis latest medical information showed

Not for the first time, TAA’s case manager was confronted with such statements as ‘you all are incompetent’ and ‘the insurance company just want to save money’

that the patient had been confined to bed for three weeks, and was incontinent. Te patient needed 24-hour nursing care. Te family declined the recommendation to admit the patient and requested instead that he travel home in business class. TAA contacted the initial treating doctor in South Africa directly and was informed that the patient had not revisited the hospital again, and that in his opinion, based on the diagnoses, the patient was still unfit for travel – even via an air ambulance jet. Based on this information, TAA again contacted the son and strongly suggested that his father be brought back to the local hospital, as they had not seen him since he first presented there for treatment. After

one full day of discussions, TAA convinced the patient’s son to transfer his father to the hospital where urosepsis was diagnosed. Te patient was in a bad general condition. In all probability, he must have suffered from a third heart attack about three weeks beforehand, for which he had likely not received any medical treatment.

Finally brought home Te patient needed to be transferred to a specialised hospital in order to receive better treatment. During the attempt to transfer the patient, he suffered from cardiac complications, leading to the cancellation of the transfer. His son and wife wished to bring the patient home in any case, and they agreed to sign a consent form to undertake the full risk for the patient’s transport. In co-operation with the insurance company, TAA made all the necessary arrangements and the patient was flown back home via air ambulance jet. He managed to make it back home, but unfortunately TAA was informed by the insurance company that he died in a nursing home only nine weeks after his return. His wife was treated in a local hospital and is still in rehab. In summary, this case highlights the challenges that case managers are often faced with in the gathering of accurate information. Tis becomes even more complex in a situation where, for all parties involved, time is a crucial factor. While the emotional aspect of a case must always be taken into account in case management, the accuracy of patient information remains the most important consideration when providing effective assistance. ■

| 27 International Travel & Health Insurance Journal

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