Robert MacAuley was on a Caribbean cruise with his wife, Wanda, when what started as a stomach pain derailed their vacation.
Suddenly, MacAuley was also spitting up blood.
“I looked at my wife and said — we need to go back to the cabin. This doesn’t look good,” MacAuley recalled.
The MacAuleys rushed to their cabin and called the ship’s emergency line while Robert’s bleeding worsened. Doctors onboard couldn’t stop the bleeding, which was in Robert’s esophagus.
As crew members donated blood for four transfusions for MacAuley, the captain rerouted the ship to the nearest port: Cartagena, Colombia.
Getting coverage abroad
Medical emergencies are always scary, but can be even scarier in a foreign country. A combination of MacAuley’s benefits and dedicated member advocates from Blue Cross and Blue Shield of Illinois (BCBSIL) was able to get MacAuley the help he needed.
BCBSIL members, depending on their plan, are usually covered by the BlueCard program and Global Core.
“When Blue Cross members travel internationally, they’re able to bring their benefits with them,” said Kevin Thorn, a strategic product manager in product solutions with BCBSIL. “It’s an extension of the domestic benefit.”
MacAuley had Global Core coverage as part of his plan from his employer. But a set of extenuating circumstances meant MacAuley needed more help.
The Colombian hospital where MacAuley was taken initially wouldn’t accept payment from Blue Cross and Blue Shield. Instead, it asked MacAuley’s wife to pay out of pocket for the emergency treatment.
MacAuley has nonalcoholic fatty liver disease, a chronic condition that can cause the liver to harden, making it more difficult for blood to pass through. Blood may then back up into the esophagus and cause a rupture — which is what happened to MacAuley on the ship on Oct. 30.
The care team at the Colombian hospital was able to treat MacAuley’s medical emergency but wasn’t equipped to treat the condition that caused it.
“That’s when Amber got in the picture,” MacAuley said.
A human touch
Amber McLean is a customer advocate specialist with BCBSIL who connected with MacAuley on Nov. 6.
“He needed someone human on the phone,” McLean said of MacAuley. “He was in a foreign country.”
McLean immediately made calls and sent emails to escalate the situation.
She contacted Alexandra Forrest, a client service specialist with BCBSIL. Forrest acts as the liaison between clients and members.
Forrest and McLean were able to work with the BlueCard team and get the Colombian hospital to accept payment from BCBSIL. But When McLean called MacAuley to give him the good news, he sounded much sicker than before.
“He didn’t sound good,” McLean recalled. “He said it’s not about the money, it’s about going home and getting treated.”
Specifically, he needed to be transferred to his doctor at Vanderbilt University Medical Center in Nashville, Tennessee, where the care team knew him and his medical history.
But the Colombian doctor had checked a form saying MacAuley wasn’t facing a life-threatening condition and the hospital was able to treat him, making him ineligible for a transfer.
McLean facilitated a call between one of the Global team’s Spanish-speaking nurses and the doctor in the Colombian hospital. It then became clear that MacAuley needed more advanced care outside of Cartagena.
The next challenge was getting MacAuley all the way to Nashville. His plan would pay for a transport to the nearest facility able to treat the condition — and that was Miami.
Forrest put in a request to MacAuley’s employer to see if the company would make an exception to get him to Tennessee instead.
“The culture at (his employer) is so employee-centered,” Forrest said. “They immediately said, ‘Bring him home.’”
The team got approval on the morning of Friday, Nov. 8, to transfer MacAuley to Nashville.
“We were so happy. We were all crying on the phone,” McLean said of the call when she told the MacAuleys the good news.
A day later, MacAuley landed in the U.S. His doctor in Nashville then found major blood clots in MacAuley’s spleen and digestive system.
“No one was looking for anything like that down there (in Colombia),” he said.
MacAuley had surgery to address the blood clots and is getting regular checkups with his doctor in Nashville. He is now back at work. He said he owes McLean a lot.
“Amber was a godsend, really,” MacAuley said. “She never one time ever said no, I’m not doing that. She said, I’m going to do everything for you. I’ll be here for you. We told her she was our guardian angel.”
McLean’s quick, persistent actions left an impression on Forrest as well.
“This job, you never know what you’re going to get day to day, but the one thing I know for sure is the people I’m working with are extraordinary and everyone truly cares,” Forrest said. “They’re of the highest caliber and quality.”