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Expat health insurance saves missionary with leprosy

Changed lives through one-to-one global health care support

When Sister Anne* made a commitment to impact others through mission work, she had no idea how powerfully her own life would be changed by a trip abroad.

The dedicated missionary had traveled to the United States from her home on a remote South Pacific island to work with others in need through a faith-based nonprofit organisation based in the US. Near the end of her mission, local doctors who were concerned about a skin condition she’d had since her arrival in the United States decided to do a biopsy.

The surprise diagnosis: leprosy, a disease that’s been nearly eradicated in the United States but remains widespread in certain pockets of the world. And to complicate matters, leprosy is not always easily detected or treated properly — especially in developing regions and without access to quality health care.

In Sister Anne’s case, she started on the treatment regimen recommended by consulting specialists in the United States, but soon found that she was not able to tolerate the standard leprosy medication. After weighing up the alternatives, her doctors decided that the best remaining treatment option for Sister Anne would include a long course of thalidomide — the drug that is best known for causing birth defects in the 1960s and is now strictly controlled on a named patient basis.

But complications soon arose when discussing Sister Anne’s return to her home country and her access to treatment there. This resulted in a call to Aetna International, the nonprofit organisation’s global health insurance carrier. Aetna’s International Health Advisory Team (IHAT) assessed the situation. The clinical team was told that Sister Anne’s complex medical conditions required treatment with five over-the-counter and 13 prescription medications — yet access was a real concern. In her home country, it was common practise for a central hospital to distribute medicine to outer island clinics through irregular shipments and local ferries. And since there were no approved thalidomide providers in the South Pacific, a prescribing physician affiliated with dispensing pharmacy would have to enrol in an educational program and receive training by the thalidomide manufacturer.

James*, an experienced clinician on the Aetna International care management team, got to work on this complicated situation. He soon found that the only provider willing to be trained in thalidomide administration was in Fiji. This meant that Sister Anne would have to make a difficult day-long trip each month to continue her treatment. After extensive consultations between James and various medical professionals, it was decided that she should instead remain in the United States until her thalidomide treatment was complete.

James worked with Sister Anne’s nonprofit organisation and the appropriate authorities to get the approval needed to extend her stay for medical reasons. Once her thalidomide regimen was completed, Sister Anne would need 11 other medications shipped to her home. Over a six-week period of focused collaboration, James found a solution. He was able to coordinate directly with Aetna’s contracted suppliers, who ship outside of the United States, to fulfil the complex needs of Sister Anne’s treatment. This included arranging for one type of medication to be shipped to Sister Anne’s home country from Switzerland.

Several months later, Sister Anne reported that she was managing her conditions quite well from home. She said that this was due to the convenient access to the shipped medications, as well as the follow-up consultations and care she received from James and her health care providers in the United States.

For Aetna International, this type of personalised assistance and intervention is not unusual. Its care management team is accustomed to going above and beyond to provide the one-to-one support members often need when living in an unfamiliar region.

"We are there for our members before, during and after their trip — no matter where in the world they go,” says Stella George, Aetna International’s Head of Americas Care Management. “We do so much more than helping our members understand their benefits and find quality health care providers. Our clinicians listen to member concerns, help them with access to care and resources, and serve as their advocates. In short, we offer whatever one-on-one assistance is needed to ensure our members get the right care, at the right place and time, so they can successfully complete their assignments and thrive."

Leprosy infographic – This infographic shows Aetna International's medical care and emergency response teams in action, and how we make sure our members get the right treatment in the right place at the right time.

*Names have been changed to protect the privacy of our staff and members.

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