When member Mike G. needed support most, Regence was there

In his 39 years, Regence member Mike G. has been through a lot and then some. Multiple serious car accidents. Substance use disorder. A stroke. Epilepsy. Kidney cancer.

With each new health challenge, the Cambia Health Solutions* employee tackled it with fortitude and good cheer, coming out the other side. But nothing could have prepared him for what happened earlier this year.

After a birthday celebration, Mike woke up the next morning feeling off. Within days, he was violently ill. He eventually began vomiting black bile and couldn’t recognize himself in the mirror. His wife called 911.

Critical condition

At the hospital, doctors initially suspected inflammation of the intestine, but Mike’s condition rapidly deteriorated, landing him in the ICU. Before he was wheeled into the OR, he was asked: Are you an organ donor? Do you have a will?

During the eight-hour surgery, surgeons discovered his body was in sepsis. They removed sections of intestine and colon that had died, working to halt the life-threatening infection.

Mike woke up to a colostomy, which is a pouch outside his body where the digestive system was now routed to allow his intestines to heal. A clear bandage with foam beneath it was covering the large surgical wound to protect it from infection. Tubes connected the bandage to a wound vacuum device to promote rapid healing. Mike would be permanently attached to this device for the next few months.

“I was obviously glad to have survived,” he says. “But waking up and learning I had all that was quite a shock.”

An unexpected lifeline

While recovering in the hospital, Mike got a call from a local number he didn’t recognize.

On the other line was Loyette M., RN BSN, a Regence nurse care manager with 29 years’ nursing experience. Mike’s hospital claims had triggered a flag for Regence Care Management services, and Loyette reached out to offer support during his recovery.

“A colostomy can be difficult to manage,” Loyette explains. “You have a bag that involves quite a bit of care associated with changing it and managing the appliance. And it’s not always easy to manage or the most comfortable for people to care for. It takes a lot of time, support and patience for someone to learn this skill.”

Her first task was to smooth out a hiccup with home health services, connecting him to an in-network agency so his nursing support at home was covered under his health insurance plan.  

Every time Mike called, Loyette answered his wide range of questions or got back to him quickly with an answer. When he worried something was wrong with his recovery, she reassured him, and when something needed attention, she acted fast.

“I never once felt like I had a question I couldn’t ask her,” Mike said. “It was always transparent.”

Knowledgeable support

Over the weeks that followed, Loyette became like a “trusted family member, one who’s medically trained,” as Mike describes it.

She helped him navigate the overwhelming world of ostomy supplies: powders, creams, adhesives, and equipment that can be hard to manage at home following a hospital discharge.

She guided him through managing his wound vac, advising him on when to change canisters and how to align the canister supply with his health plan benefits.

When one of his medications required a prior authorization and hit a wall, Loyette knew exactly who to call at Regence and resolved it before Mike even left the pharmacy.

“It was beyond beneficial,” says Mike. “I could focus on healing. Working with a care manager was a joy.”

“You’re cared for”

He explains, “When you have a dozen different doctors and specialists you’re dealing with, that one point of contact for support is just super beneficial. What’s the word I’m looking for? A warm, fuzzy-blanket feeling. When you know you’re cared for.”

Mike spent three months at home recovering. He couldn’t drive. He credits Loyette with keeping his spirits up during that time. His doctor wanted him to lose weight and suggested GLP-1s.  

Instead, Loyette encouraged him to walk. Just around the block at first, then farther. Because of that, Mike never needed physical therapy. His wound, which doctors predicted would take 90 days or more to heal, was fully healed in about 80. His doctor called it remarkable.

Return to health

Today, Mike is back at work and looking forward to surgery this fall to reverse the colostomy and return to normal digestion. He says he’s healthier than he’s been in years. He continues to walk, visiting the waterfront near his home with his wife each evening.

While this was the worst experience of his life, Mike says, reflecting, it was also the easiest, thanks to Regence Care Management. Don’t wait to see a doctor, he urges, particularly men. And don’t ignore the call from a Regence care manager.

For Loyette, the message is simple: “This is available to you at no cost. You don’t have to wait for us to call. Reach out.”

*Parent company of Regence