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Not Subjecting Anyone Else

Published July 20, 2018 by lynn k scott

Another failed attempt by Sutter Health Plus to do their job; help patients get treatment.  My journey has taken me to the point that I no longer give a damn what I say or how I say it, because when it comes to dealing with doctors, their staff and the insurance agencies, they have little disregard (in my experience) to actually assisting the patient; in the manner that works best for the patient.

I filed a complaint against my current oncologist’s staff for failing to do their job.  Of course, every complaint is done the same way.  Patient complains, grievance department calls doctor’s practice, “file review” and then issues a form letter that ignores half of what the actual grievance was about, dismisses patient concerns (as if they have been handled) fails to contact patient for clarification on information obtained from doctor’s office and refers patient back to PCP (Primary Care Physician); which patient has never seen.  The PCP is supposed to help with the oncology referral.

The patient is being seen by someone and wants a different doctor.  I didn’t go to medical school, but I’m smart enough to realize that the existing doctor, who already has some knowledge of the patient, should be making (and can make) the referral.  Why should the patient pay more money in copays to see an unfamiliar doctor, have to recount (AGAIN) why they need a referral, to a doctor who has no vested interest in that patient?  I mean, as an HMO, the PCP already gets a monthly stipend for accepting to see that patient; if and when that ever happens.

I’m a ‘bad’ patient, so I have to speak with a “case manager”.  I was already told by Sutter Health Plus, last year, they don’t have those.  The “case manager” is merely a person in the grievance department, who is assigned to deal with me when I call customer service.  Why?  Because I’m not allowed to be upset at their half-assed attempt of treating my disease.  After all, we have to protect the fragile ears of customer service reps, from upset cancer patients, asking…no begging….for support.

The twist in all this, is this person is on the team that reviews my grievances.  They rule the same way, EVERY TIME!  I am not allowed to have someone else review my grievances.  I am only allowed to speak with Carla (my “case manager”) or her supervisor.  I have asked repeatedly to speak to the manager who is above Carla and her manager.

Today, Carla had the nerve to say, “we will not subject anyone else to you and your behavior”.  Hmmm….make me continually deal with people who are part of the problem instead of passing the issue to someone who  1) might have a different perspective on the situation, 2) someone who would be a fresh start and 3) someone who might have the ability to see that my issues are addressed.

I’m such a detriment to the medical community, that I’ve been blackballed by the insurance agency itself.  Could I be nicer?  Perhaps.  Am I going to….NOPE!  Why?  It’s simple, I have had to fight for my basic rights, that I PAY for, just to be treated.  I am holding people responsible and I will not be a doormat because I refuse to let them make any further money off of me because they think they are god in deciding if I live or die.

Sutter Health Plus is in need of major reform (as are most insurance carriers).  Carla in claims needs to be retrained (as does her manager -with whom I will not speak with again).

At this point, I will be utilizing the UC Davis emergency room going forward.  I’ll incur the annual maximum charge and then they can run every test they want, but I’ve hit the maximum.  No patient should ever feel like they are being dismissed or given up on.  Sutter Health Plus (Sacramento, CA) has done just that!

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Cancer Journey: Part 14

Published June 21, 2018 by lynn k scott

After yet another phone call with Sutter Health, my oncology referral to Sacramento was denied.  The reason is the doctor is limiting her practice.  They referred me back to Vallejo.  I lived in Vallejo for eight years.  It’s gotten progressively worse and we moved away from that cesspool over six years ago.

I will be getting to see a native-English speaking doctor.  However, she is only in Vallejo one day a week, because her primary office is in a better city.   Colored me surprised…

I tried to make the appointment yesterday, only to be told the new patient coordinator was already gone for the day.  What?  It was 2:15 p.m.  Must be nice.  I left a voicemail that I needed to make an appointment and asked her to return my call.

Now, I tried to schedule an appointment with this provider three months ago.  They were unable to accommodate my schedule and Valerie, the coordinator, either hates her job or believes she is above us poor cancer patients.  I had the displeasure of dealing with her again.

Conversation starts with her calling me back and asking how she could help me.  Ummm…I know I left a message regarding booking an appointment (you know…you’re job – but I didn’t say that).  So, we had to start from scratch.  She never bothered to look for my referral before calling me back.  She had the wrong address (even though I corrected it last time we spoke and it was on the referral).  She didn’t like my exasperated tone.  She kept telling me to stop yelling at her.  At that point, I wasn’t.  However, after the third time she said it, and I told her she was part of the problem, she said, “did you just hear yourself?”

It was then I asked for her supervisor.  I wasn’t going to tolerate her crap a second time around.  Even my coworker, who could hear everything, and knows I wasn’t initially yelling, said, “I can’t believe how much trouble they are causing you.”  See, it’s not just me.  Part of the biggest obstacle of seeing a provider is their staff.  I finally raised my voice at Valerie, didn’t want to make a liar out of her, requested her supervisor and muttered a few not-so-nice words.  Ooops…she heard me…oh well…

Spoke to the supervisor and she starts to tell me that the doctor doesn’t go to the city I live in.  Umm…DUH!  I never said I wanted to see her there.  I knew she was in Vallejo and that’s I was trying to make the appointment.  Valerie couldn’t even get that straight.  We made the appointment.  I was supposed to receive a form to authorize the release of my records.  Three hours later…NOTHING!

I found the form online (which the supervisor should have known it was there).  Completed it, called for the fax number and printed the confirmation that it went through.

So now I sit and wait until my appointment next week.  The only benefit of seeing this doctor is that if I have to have any procedures, I will cross the bridge (same distance as going to Sacramento) and be seen in a better facility, in a better city.

Physicians and their staff need to be held to some sort of standard by the insurance carrier.  Patients need to have a recourse against them and their ‘holier than thou’ attitude.

I admit, I am less-than Christlike in my dealings with the medical community.  I attempt to “behave” for every interaction, yet it rarely plays out that way.  I keep praying for tolerance, but I’m not great at waiting for a response.  I have been “labeled” by my insurance and the providers; almost like a medical blackball.  I’m not giving up and I’m going to raise Cain, Hell and whatever else needs raising til patients are seen as people who need help; attitude be damned!

Cancer Journey: Part 3

Published November 20, 2017 by lynn k scott

The second cycle, of six, started today.  One cycle down?  Not really…and here’s why…

The doctor’s office never discussed the actual dosage that would be mailed to me.  Seeing as these are chemo pills, you can only get them from a specialty pharmacy, via couriered delivery.  The last pharmacy only sent one of two bottles; and the lower dosage of the two.

Then, I find out, my doctor’s office failed to verify which specialty pharmacy the insurance used.  This makes a difference because using the incorrect pharmacy could make the patient fully responsible for paying for otherwise covered medication.  Finally, the correct specialty pharmacy was able to send all the correct medication.

Moving on…I get my blood draw and then see the doctor the next day (like I’m supposed to).  The nurse walks up to me with someone else.  The first person continues on and I see someone standing near me, but not saying anything.  I am playing a game on my phone, passing the time until I am called.  Several minutes pass and she said, “whenever you are ready”.  Wow!  This office really has communication issues.  That being said, my patience for dealing with them was ‘running on fumes’.

I had convinced myself to just get through the appointment.  I could do it!

The office and its occupants had other ideas.  The nurse directed me into a room, never took vitals, told me to take a seat and the doctor came in.  They wanted to “talk”.  The conversation that took place was an already decided upon course of action under the guise of a mutually beneficial conversation.  You know, like when you’re boyfriend or girlfriend says they want to talk and then tells you it might be best if you both saw other people.  Wait!  Did you get the license plate of the bus that just ran over me?  Starting to get the picture of how this office operates?

Basically, I was supposed to sign a document regarding my treatment and they were going to continue letting me receive treatment.  Hmmm…..I already pay insurance premiums for that “right”.  I signed their document and added, “signed under duress”. This didn’t sit well with them.  My stating I was forced to sign their document, which is a prime example of duress, gave them just another reason to say they weren’t going to treat me.

I knew vitals are required after every cycle.  They made no attempt to take them.  They knew I had my next dose of medication.  They knew I mentioned working on getting into a another practice instead of dealing with them.  I don’t trust doctors to begin with and this office was a cancer to my treatment.  Yea….it was that detrimental.

Am I a difficult patient?  Yup!  Do I deserve to have the doctors and their staff treat me with professionalism?  Yup!  Do I deserve to receive clear communication so I can give informed consent for my treatment.  ABSOLUTELY!!!!

However, there is no law from preventing medical doctors from withholding treatment from a patient; even with a potential life-threatening disease.  They don’t need permission, a hearing to remove the patient, or even assist in transferring them to another provider.

What if there isn’t another provider in the area?  Oh well, that’s the patient’s issue; not theirs.  When a practice discharges a patient, as they just had, they won’t take your calls and tell you to go to the Emergency Room if any issues arise.

After all of that, perhaps it was a blessing.  Don’t get me wrong.  I uttered several choice words, shed a few tears, said some prayers and moved on.  I’m getting set-up with a new  provider, within a new network.  I’ve had some friends (online and at church) offer support.

I’ve already got an appointment with a new primary physician, so I can get an emergency oncology referral.  Hoping she can order the necessary blood work, get the next dose of chemo ordered and I can follow-up with my new oncologist.

The situation is less than ideal.  I was on the fence about switching to another carrier/provider.  Perhaps being kicked out of a less-than-healthy medical practice was what was needed.  The group I am switching to has a very good reputation for their oncology department.  Who knows….maybe they will even offer some cancer support groups that weren’t available with my other provider.

Treatment has its ups and downs.  This past week has been such an emotional roller coaster.  I’m looking forward to moving on and getting better.

 

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