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REALStories of Success, One Member at a Time 

AMERIGROUP values the difference we make in our members' lives through dedicated outreach. That difference can best be witnessed in the REALStories demonstrating achievements and progress for the many different individuals we serve.

Helping Mothers and Infants

Katoria Tinsley was worried. A mother of two girls, both of whom had been born prematurely, Tinsley had seen both struggle with health problems from birth. As she awaited the birth of her third child, she very much wanted things to be different.  Tinsley learned early in her pregnancy that this time there would be a clear difference. This time she was covered by AMERIGROUP.

When her two older children were born, Tinsley recalls, she was covered by traditional, employer-financed insurance.  “There was nothing spectacular about it,” she says. “If I ever called, I’d get bounced around to nine different customer service reps, each of them without a clue.”

So Tinsley was shocked when she picked up the phone and AMERIGROUP was on the line. “It’s a nurse calling from AMERIGROUP and she’s my case manager, wanting to know everything,” Tinsley says. “Am I getting to my doctor’s appointments? Do I need a ride to the doctor? Am I having any symptoms? She would regularly call and ask me certain questions that might not have dawned on me."

Just as surprising, Tinsley found that getting healthcare services through AMERIGROUP was simple. “If you’re sick, you want someone who can give you exactly what you need,” Tinsley says. “AMERIGROUP has that.”

This year, AMERIGROUP will touch the lives of nearly 57,000 mothers very much like Tinsley, all of them low-income women served by Medicaid. AMERIGROUP understands that our members confront an array of economic, cultural and practical barriers that can make it very difficult to get basic healthcare. We’ve designed a prenatal and neonatal care program that breaks down these barriers and connects our moms and babies with the care they need. Here’s how it works:

  • We don’t just wait for our members to seek prenatal care; we look for members who might be pregnant.
    AMERIGROUP maintains member profiles that include about a dozen indicators that suggest someone might be pregnant. If any of these indicators show up – for example, if a member gets a prescription for prenatal vitamins – we contact that member and ask if she is expecting.
  • If a member is pregnant, we conduct a screening to determine whether she has health problems that make the pregnancy high risk.
    AMERIGROUP has designed a brief but thorough telephone interview that assesses whether a member has health issues that might lead to a difficult pregnancy.
  • When a pregnant member has special health needs, we assign a nurse as her case manager to help her identify and obtain the right care.
    By assigning an individual case manager to work with a pregnant woman, we can significantly decrease the chance that her baby will be born prematurely.
  • We ensure an obstetrician will be available to treat every one of our members who is pregnant.
    Unlike traditional Medicaid, which puts the burden of finding a doctor on individual recipients, AMERIGROUP constructs a network of doctors and specialists who agree in advance to treat all AMERIGROUP members. The providers must be in locations that are convenient to the neighborhoods that AMERIGROUP serves. If an AMERIGROUP member does not choose a doctor and obstetrician, appropriate physicians are assigned to her.
  • We follow up repeatedly with our members who are pregnant.
    In states that provide a transportation benefit, we arrange for our members to get a ride to the doctor’s office. We remind our members by phone and mail when they have scheduled a doctor’s appointment.
  • We provide a 24-hour-a-day Nurse HelpLine to address all our members’ healthcare concerns.
    To get reliable healthcare information to our members whenever they need it, AMERIGROUP offers a round-the-clock health line that provides simultaneous translation in dozens of languages. We also offer award-winning, multilingual materials that help our mothers understand how best to care for themselves and their newborns.  The results of this program are significant. The rate of premature births among AMERIGROUP members is less than 10 percent - about half the rate of African Americans nationwide (17.9 percent) and well below the overall national rate (12.5 percent).

This means that many more babies get the healthy start in life that they deserve. And there is less demand for the extremely expensive treatment measures required by premature infants, enabling the state governments that pay for Medicaid to save money.

For Katoria Tinsley, the results were not measured in numbers. She gave birth to her son, Reggie, after carrying him through a full nine months of pregnancy. And she values the quality healthcare AMERIGROUP has provided for Reggie and his sisters, Ryan and Miracle.
“What I feel with AMERIGROUP is relief,” Tinsley says. “It’s a relief to know that my health insurance will take care of my children. I know they’ll get what they need. And I know the number to call to make sure they get it.”

“What I feel with AMERIGROUP is relief.  It’s a relief to know that my health insurance will take care of my children.  I know they’ll get what they need.”
KATORIA TINSLEY
AMERIGROUP Member