Pediatric Case Study

Situation
A 14-year-old DAKOTACARE insured family member was diagnosed with Hodgkin’s Lymphoma. The child was not able to travel to the clinic because of susceptibility to infections due to the chemotherapy regimen at the time. The mother of the child called DAKOTACARE to let them know they were receiving denials for clinic personnel to draw blood for laboratory tests in the patient’s home.

Solution
DAKOTACARE brought the situation to the attention of DAKOTACARE’s medical director. He determined there was medical necessity for the clinic to draw blood in the home. Clinic personnel were able to draw blood instead of having to pay extra costs for home health services

This coverage not only saved the child from unnecessary infection risks, it also saved the family and the entire plan extra costs