Not every recommended surgery is the right course of action. This case study illustrates how APRIL International's clinical review process identified a misdiagnosis and helped a member avoid an unnecessary procedure.
How APRIL's Medical Team Reviews Care
Every planned hospitalisation or treatment recommended to a member is reviewed by the APRIL team. For the most complex medical cases, our in-house medical team composed of doctors and nurses conducts an in-depth clinical review. Their role is to ensure that members receive the right care, from a quality provider, at a fair cost.
In most cases, the review confirms the recommended treatment and the member proceeds with confidence. Occasionally, when our clinical review does not fully align with the proposed plan, the team steps in to help the member explore better-suited alternatives.
A Case That Prompted A Deeper Review
A member in Hong Kong was advised to undergo ear surgery for a suspected cholesteatoma – an abnormal growth that, if confirmed, typically does require surgical intervention. When the medical team reviewed the case as part of their standard process, the CT scan did not clearly confirm the diagnosis.
Rather than challenge the treating doctor directly, the team recommended that the member obtain a Second Medical Opinion through APRIL's partner, Teladoc Health. With a global network of over 50,000 medical experts across all specialties, Teladoc connects members with leading clinicians, regardless of where they are located.
An independent ENT specialist affiliated with Harvard Medical School in the United States reviewed the full case file: imaging, clinical history, and the proposed treatment plan. The conclusion was clear: surgery was not warranted.
The Right Decision, On Every Level
The most important outcome was clinical. The member was spared a significant surgical procedure, with its inherent risks, general anaesthesia, and recovery time.
In addition, the estimated cost of the avoided surgery was USD 48,000. This type of proactive medical review is also what allows APRIL to maintain sustainable premiums over time, ensuring that members continue to benefit from quality coverage at a fair price.
A Systematic Approach To Care
This case reflects how APRIL operates every day. Our medical team intervenes to ensure clinical accuracy. And when the right medical decision is made, the financial benefit follows naturally.