How Health Insurance and Care Teams Solved Patient’s Pain Problem
When you’re in pain, your focus is simple: find a way to stop it. Jose Martinez had months of pain in his right side, between his hip and stomach. Now that pain is gone.
Martinez got help starting with direction from health insurance team at Avera Health Plans. That led him to see a specialist who diagnosed his severe hernia, which needed surgery.
When it began, it was a painful mystery.
“I’d been so tired, sometimes nauseous, and it hurt just to walk around,” said Martinez, a translator and English as a second language paraprofessional. “I had so much help and the connections that led me to today,” he said. “All the professionals helped me figure out what was wrong.”
The Benefits of a Connected Health Network
Martinez lives in Flandreau, SD. He’s a health-conscious person.
Before moving to the United States, he worked with a dietitian in El Salvador. “She helped me adjust my diet. I lost 15 pounds,” he said. “Your health is important, and you can’t stay healthy if you don’t take action.”
Martinez had a mix of symptoms, including pain, higher blood pressure and nausea, so his team thought a specialist – or perhaps more than one – would be best for him.
Since he’s an Avera Health Plans member, he collaborated with his benefits team. They helped guide him to a good outcome.
“An integrated system can save stress and time for a patient,” said Avera Health Plans Chief Medical Officer Preston Renshaw, MD. “Complex cases can be resolved in a convenient way.”
After lab testing in his hometown, he received a referral to see Aaron Burkhardt, DO, Avera Medical Group Internal Medicine in Sioux Falls.
Internal medicine specialists focus on adult care, and they often solve “puzzles” since patients have more than one condition or issue.
“An Avera strength is how we funnel cases like Jose’s and make sure the patient gets help,” said Burkhardt. “Something like a hernia can be missed when you’re not looking for it.”
Burkhardt said his specialty focuses on problem-solving. When patients sometimes face several ailments or conditions at once, internal medicine doctors find solutions.
“Sometimes we say, ‘Don’t look for the zebras until you’ve rounded up all the horses,’” Burkhardt said. “With Jose, there was certainly a complexity that fit our area of expertise.”
Answers and Solutions to Jose’s Pain
“When we realized Jose’s hernia was in an area with many organs, muscles and possible indicators of other problems, the next steps were straightforward,” Burkhardt added.
Martinez was referred to general surgeon Michael Brozik, MD. “The procedure to stop his pain was a success.”
Avera physician Christine Pocha, MD, a specialist with Avera Medical Group Liver Disease in Sioux Falls, also helped Martinez address a condition known as fatty liver disease.
“I’m still getting used to living in the U.S., so having so many experts providing assistance really helped me,” he said. “I’m glad my health insurance provided the guidance that helped me get better.”
This combination of experts – all compassionate and patient – led to relief. Martinez says he’s developed a trust that’ll last.
Martinez also gained a primary care provider in Burkhardt who can guide his recovery and other health concerns. “Now I can walk, work, do almost anything and it doesn't hurt,” Martinez said.
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