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Case Managers Give a Helping Hand

Joseph Lopez

Arizona resident Joseph Lopez had always been in relatively good health. Though he was exposed to Hepatitis C while performing a procedure as part of his studies to be a funeral embalmer, he'd always been symptom-free. In fact, his Hepatitis C infection wasn't even detected until he was age 40. But, over the years, his liver function tests were regularly monitored and he experienced no problems with the condition.

Joseph's difficulties actually began a decade after his hepatitis infection was diagnosed. In 2005, he started feeling digestive discomfort. Ironically, the symptoms reminded him of a case he had recently been involved with as a pathology technician – someone who assists in post mortem exams. The autopsy found that the cause of death was cancer of the liver resulting from Hepatitis C – and the medical report described symptoms that were eerily familiar to Joseph.

After a trip to the hospital because of worsening pain, it was discovered that Joseph had a 4x6 cm. tumor growing in his liver – and that it was most likely malignant.

UnitedHealthcare: Supportive, caring

Thankfully, Joseph was covered under his partner's health insurance, UnitedHealthcare. At the urging of his partner's doctor, Joseph flew to Southern California for further testing and consultation. There, the malignancy was confirmed and specialists began reviewing his case to determine if he was a candidate for the liver transplant program at UCLA Medical Center.

"I was required to have extensive testing and evaluative procedures before I could be considered for a transplant," he said. "It was imperative that I had adequate insurance and a cooperative insurer to cover and support the transplant processes."

Joseph knew he was in for an uncertain journey. Would he be accepted into the transplant program? How long would he be on a donor waiting list?

"It was at this time that I began to work with my transplant case manager, Pat Klemm. Pat provided guidance, consolation and benefit confirmation as I worked through the incredibly complex process of admission to the transplant program," he said.

Getting on a transplant donor list is a lengthy, exhaustive endeavor. "You go through an entire program where they interview you, take what seem to be thousands of tests – from psychological to checking out a cracked fingernail. They are very thorough. Of course, they check out your insurance coverage, too."

When Joseph applied for the surgery, Pat had prepared all the important paperwork in advance, including obtaining pre-approval from the insurance company. This preparation helped him get accepted and shoot right up the list. "Pat had taken care of everything," he said. "She played an integral part in getting me access to a transplant."

Steps back, steps forward

Initially, doctors at UCLA planned to perform a resection – the surgical removal of a portion of an organ. The goal was to completely remove the tumor growing on Joseph's liver. Hopefully, this would save his liver and make a transplant unnecessary. But then he hit a roadblock. The surgery was cancelled because the doctor determined that they'd have to take out more of Joseph's liver than they originally thought. This was too high a risk – he may have gone into liver failure and died. Of course, he couldn't help but feel disappointed by this decision.

"Pat gave me hope that it was just a part of the process. She told me not to be discouraged, that the surgeons knew what they were doing," he said. "Because of Pat's continuing efforts, and my incredible medical team, I felt comforted and confident that a transplant would come through."

After more than year of waiting, on Feb. 14, 2006, Joseph received an early morning Valentine's Day surprise: a phone call about an available liver. He and his partner drove for two hours to the hospital, only to find out that the liver wasn't a match. Discouraged yet again, "We tried to go about our day, but it was difficult. But again, Pat was there for me, giving me the support and reassurance I needed."

Later that same day, Joseph received another call. They had another liver that someone else on the waiting list had turned down. Talk about timing. They rushed to the hospital again and this time it was a match. Joseph came out of surgery 16 hours later.

What he found out after the procedure is a case in point about timing being everything. After he received his new liver, the doctors found that 27 or more new tumors had started to grow on the bottom side of his own liver. If he hadn't had his transplant surgery when he did, he would have gone in for the MRI that had been scheduled for Feb. 18. Doctors would've seen the new tumors. "I wouldn't have been able to get a transplant. The MRI results would've knocked me off the list," he said. They also discovered after the transplant that his own liver probably would only have lasted 60 to 90 more days.

New liver, new life

Joseph faced a long recovery period, which included:

  • Multiple daily dosages of anti-rejection drugs and injections
  • Nearly daily visits to the hospital for the first few months after surgery
  • Continued testing and procedures
  • Re-admissions to the hospital for monitoring
  • Drastic lifestyle changes

"All of it was made a little easier thanks to the exceptional and compassionate coverage of my needs by UnitedHealthcare and Pat Klemm," he said. Joseph has returned to his normal activities and continues to be healthy.

Now, Valentine's Day is extra special to Joseph. It's the day he was given a new liver and a new lease on life. "I continue to thrive with my new liver," he said. "There is no adequate expression for the gratitude I feel for the kindness and care UnitedHealthcare provided to me during my transplant journey."

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