“More than just a chart”— nurses and the insurance industry

Amanda Fougere, 3rd from right, enjoys an outdoor lunch in Philadelphia with fellow IBC nursing interns.

Senior Amanda Fougere found her summer internship as an Independence Blue Cross (IBC) Nursing Scholar to be an exciting and varied experience. Assigned to the Care Management Coordination Utilization team, she worked with staff to deal with cases between the hospital and the insurance company, reviewing patient charts and, based on an established system, indicating whether the hospital is reimbursed or if the case should be referred to a medical director.

In this role, Amanda expanded her knowledge not only of where nurses have an impact in the industry but also of patient scenarios and treatments, and along the way honed her own critical thinking skills. “I had to know what was going on with the patient and then make sure I knew what I was looking for, like different tests and lab results,” she explains. She also appreciated the wisdom and advice from experienced nurses with whom she worked. As a scholar, Amanda also traveled around the organization, shadowing different people. “For example I've been able to shadow people in case management, where they call patients and do a lot of teaching,” she explains, noting that those nurses look at the person’s care holistically and help with not only health problems, but also make referrals to help with monetary issues and support groups. She spent time with a medical director who conferred with colleagues on the necessity of patient medications and procedures, and with her manager, listened to appeals for coverage for procedures and medical devices. 

“I've really been able to see how an insurance company works,” notes Amanda. “I was also able to help with a project for worksite wellness, where we had to devise different games to help teach kids about healthy eating, portion sizes and the benefits of certain foods.”  She views this internship as a strong enhancement to her nursing education, saying “I have learned what's important to look for in certain patients and this internship has helped solidify my knowledge.”

Reflecting on the industry, Amanda describes the heart of the organization, “The people here genuinely want what is best for the members (patients) and try to make things work or even offer ideas for alternative solutions. It is important for me that the members are advocated for and I definitely have seen that here. Nurses use their clinical knowledge to find if a patient could be at risk for exacerbating their present illness.” She further explains, “It takes someone special to be able to see past the words on the online chart and create ideas on how they can make a person’s health better.”

Amanda sees her experience as a valuable one, offering, “I have been able to accumulate knowledge of the health care process unlike many nurses. It has allowed me to change my game and be a step ahead.  It has challenged my preconceptions of what all nurses do, and has broadened my perspective on what nurses can do and how they can touch others’ lives, even while not in a hospital.”