Individuals and Small Businesses
New York’s managed care health plans provide comprehensive health care services to nearly eleven million adults, children and seniors. These New Yorkers include those enrolled through their employers and individuals who shop for coverage through the state’s official Marketplace or directly from plans. The following member* stories offer real examples about how plans support the health care needs of their members.
* Some names have been changed to protect member privacy
As Hannah S. finished doing the dishes, she pulled apart dishwasher pods that were stuck together, which burst and splattered. At first, she thought nothing of it, but after a few minutes, suddenly her vision went white and it became extremely painful. She called for an ambulance but the ambulance provider turned her away because it was “not an emergency.”
Julie M. woke up in the middle of the night and found it difficult to breathe. She couldn’t take in air, and for the otherwise healthy 58-year-old, nothing like this had ever happened before. She was advised to go an emergency department, or a designated cardiac urgent care center like, Enhanced Cardiac Access at 1785 in Clifton Park.
“Can you feel lucky that you had a heart attack? I don’t know,” wondered Michael O. It may seem strange to say, but for the 57-year-old artist, college professor, the life-changing experience has not only amplified his artistic creativity, but also taught him more than a little about the importance of self-care and healthy habits.
Simon W.* is member of United Healthcare. During a vacation in Mexico, Simon’s wife fell very ill and had to be transported to Florida. As her condition worsened, Simon worked with the hospital care coordinator to get his wife back to New York, and was told that transportation by medevac was approved.
Like most people who hear the words, “you’ve got cancer,” Krista G’s immediate thoughts were about treatment — surgery, chemotherapy, radiation, tests, and more. But that’s really just the beginning.
Even though he had health insurance, when Jeremy D. learned he needed a liver transplant, he and his daughter told his plan, Cigna, they were worried about costs and the strain it might put on Jeremey’s finances.
After turning 50, Ron W. decided he wanted to lose weight and improve his health. He started some exercise, but needed help making lifestyle changes. Ron had participated in Highmark’s work-site wellness program at his job and was introduced to Highmark’s personalized care management program.