HMO

All posts tagged HMO

Sutter Health Insurance

Published June 19, 2018 by lynn k scott

I am not an easy patient.  I have little regard for the insurance industry and the doctors it employs.  I have become less than tolerant of the medical world since my cancer diagnosis.

Sutter Health Plus is the health insurance I have.  It’s the least evil of the three options I had to choose from.  That being said, they are far from acceptable.  They care little for their patients.

On Sutter’s website, it boasts how important it is to have a doctor you feel comfortable with.  That is a fallacy.  They don’t care how far you have to travel to see a doctor.  They don’t care if you don’t want to be seen in a certain area.  They don’t care that you can’t understand who they pick for you; even after declining their physician option (multiple times).  They prefer to hire immigrant doctors compared to native-English speaking doctors.  Where medical terminology is a factor, being able to understand your physician is paramount.  Apparently, that only applies if you want to see anyone but an native-English speaking doctor.  They hire for every other language, but English is overrated.  How “PC” of them….I digress.

You can make complaint after complaint about not receiving care, but NO ONE calls you for more information.  Non-doctors simply review your file and regurgitate their initial form letter and continually resend that information to you.

They can get you an appointment in the doctor of their choice, where you don’t want to go and ignore the fact you may have employment obligations to meet.  Did I mention they will give you an appointment out of your area and when you’re not available?

Providers are allowed to drop patients prior to making sure an acceptable referral has been found.  They fail to notify the patients of the change in providers.  Nurses refuse to let you speak to providers.  The online emails are answered by nurses and not doctors.  You get the privilege of playing the adult version of “telephone”.  You never know what their response is going to be, but it rarely is regarding the original issue you are inquiring about.

They claim physicians are required to tell you that they are kicking you out of their practice.  Well, I guess finding out, via another form letter, on a different subject is their view of “notification”.

Do I hang up on them…sure do!  I say what needs saying.  They ignore what I say but mark the notes that “contact was made and patient hung up”.  They fail to mention patient stated their option wasn’t viable.  Patient can’t understand who they assign, but as long as they cover their ass with a half-assed note, I guess they did their job, right?

This is how Sutter Health Plus treats cancer patients.  Western Health Insurance does the same.  They are such a small insurance company, they allow doctors to kick patients out, after ignoring patient concerns.

Keep telling the patient they have an ulcer.  Get irritated with patient because she refuses a G.I. referral.  Blame patient for “refusing care”.  Patient goes to the emergency room, where they have to treat her.  Low and behold, patient was right – it WASN’T an ulcer.  It was a Stage 3 tumor, blocking almost 100% of the colon.  Patient could have died, but hell, as long as the insurance companies continue to make sure they are “PC”, health care of individuals be damned.

I am sure there must be some diligent doctors somewhere, but the insurance carriers, call center staff (because you can no longer call a doctor’s office directly) and their nurses hinder receiving effective and timely treatment.

I will no longer be silent.  The insurance industry needs to change; esp. when it’s an HMO.  Patients are required to jump through hoops to “establish” with providers and to obtain referrals, but the doctors are not required to treat them.

Enough is enough.  Please share.  Silence is compliance!

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