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!