Editor’s Note: A serious diagnosis takes a heavy toll on patients, medically and financially. Proactive financial navigation can make a huge difference by connecting patients with the resources they need to afford treatment. In the latest installment of our “Patient Stories” series, learn how navigator Raylena Carbone from our TailorMed Complete team advocated for a patient with arthritis.
Financial navigator: Raylena Carbone
Diagnosis: Rheumatoid arthritis
Type of healthcare organization: Health system
Medication: Renflexis (Merck)
Assistance program: The Organon Copay Assistance Program
Costs covered: ~$10,000 per infusion
Patient financial responsibility with assistance: $5 per infusion
TailorMed Financial Navigator Raylena Carbone went the extra mile for a patient with rheumatoid arthritis. She first enrolled the patient in a copay assistance program for her prescribed infusion therapy, Renflexis.
While reviewing the patient’s explanation of benefits (EOB), Raylena noticed something troubling: The patient’s insurance hadn’t paid its portion of the drug’s cost. Unless this was resolved, she wouldn’t be able to submit the claim to the copay program for reimbursement, leaving the patient with an unmanageable bill. Determined to help, Raylena connected with the health system’s billing team. She began working closely with the team to resolve the issue, keeping the patient informed.
Without Raylena’s persistence, the patient would have faced a bill of roughly $10,000 per infusion.
“The patient relies on me to be an advocate,” Raylena explains. “Even if I can’t solve the problem directly, she knows I can get her to the right person. It’s all about building relationships with patients to make sure their copay cards are working the way they should.”
Raylena’s high-touch financial care not only protected the patient from devastating costs, but also saved the clinic from absorbing a significant financial loss.
“The billing team was appreciative because that’s a cost the clinic would have had to write off,” she adds.
The story doesn’t end there. The patient continues to reach out to Raylena with questions, trusting her as a reliable partner in navigating the financial side of treatment.
Interested in partnering with our TailorMed Complete team to optimize financial assistance and reach more patients? Contact us to learn more.
