Susan Schulte rarely steps foot into the clinic, yet adults undergoing a blood and marrow stem cell transplant are sure to meet her.
As UNMC’s nurse insurance coordinator for adult bone marrow transplants, Schulte helps patients and the transplant team sort through the maze of medical insurance questions: What is covered? What isn’t? What are the alternatives, if there isn’t adequate coverage? Why are claims being denied?
UNMC’s transplant liaison with the insurance companies, Schulte works to get various aspects of a patient’s care covered. She also helps with insurance contracts, deals with insurance coverage denials and writes appeal letters to challenge their coverage stance.
“I work to minimize the financial risk to our program, physicians and to the transplant patient, both pre- and post-transplant,” she said from her eighth-floor cubicle in The Lied Transplant Center. “Insurance issues are overwhelming to most people.”
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Not to Schulte, however, who has received this month’s Chancellor’s Gold ‘U’ Award for her knowledge of the industry, while compassionately balancing the fiscal well-being of the transplant program and its patients.
“It’s very challenging,” said the Portsmouth, Iowa, resident. “The state of health care is always changing so every day I learn something new. Patients and the health-care team sometimes assume insurance will cover everything. I decipher the transplant benefits and help both the patient and providers to better understand the coverage.”
Schulte works to find alternative funding options, through the Patient Advocacy Foundation, Leukemia & Lymphoma Society, pharmaceutical companies and helping patients obtain coverage through Medicaid, Medicare and high-risk insurance pools.
“You have to be creative,” she said. “You have to learn insurance and know insurance to minimize the financial risk to our patients and facility. I like that challenge of finding a way. If there’s a will, there’s a way. People might not like the way or pursue the way, but there’s always a solution to the problem.”
Even so, it’s not a one-woman job, Schulte said. “I work with such a dynamic group of people,” she said. “My job wouldn’t be what it is without them. I can’t fix everything, but I know people in other areas that I can call who will help me find possible solutions. These people are what make my job easier and so successful. Everyone has an important role in this program. Without them it would not be the well-oiled engine that it is.”
The nurse insurance coordinator position seemed to be tailor made for Schulte, a former nurse and insurance underwriter. The position was in its infancy when she joined UNMC in 1997. Schulte developed and molded the position into what it is today.
Said her nominator: “(Susie) helps the case managers understand insurance issues with our patients. For example, my patient was not taking his medications because of something he didn’t understand, Medicaid! She went out of her way to investigate why my patient had to pay for his medications instead of Medicaid paying and to help utilize the services that are provided by Medicaid…Often times case managers present patients for transplant that may not meet the qualifications for transplant coverage. She maintains the integrity of this institution by doing the right thing, she will write appeal letters to challenge insurance companies, and she will go to bat for our patients as well as being financially responsible to UNMC.”
Schulte’s mother, Judy Funk, serves as the hospital utilization review nurse, whose insurance concerns relate to inpatient care. She has been instrumental in shaping Schulte’s desire to work with and address insurance issues, Schulte said.
Outside the insurance arena, Schulte spends time with her husband, Dan, and their five daughters, who participate in a variety of activities. She also enjoys traveling, reading, shopping for antiques and volunteering.