insurance

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Sutter Health – 9/25/18

Published September 25, 2018 by lynn k scott

It’s a sad reality when I have to document every phone call and issue because Sutter Health and its providers are fine with denying care to (cancer) patients.  If necessary, this will be a play by play for a lawyer.  I’m also throwing it out there, any lawyer who reads this has my permission to contact me.

  • Current oncologist knew they would not be under contract as of 9/1/18 – failed to notify patient in order to process a referral
    • Now have to see PCP and establish care just to get my referral
  • Try to establish care and the office sends a message and doesn’t make an appointment.
  • Call to follow-up and rude medical assistant claimed she made the call (she didn’t) and then said I swore at her (I didn’t) and disconnected my call.
  • Manage to make an appointment with another doctor in the office.
  • Received call to say appointment was cancelled because “the doctor reviewed your file and won’t see you)
  • Received a call this morning to reschedule with the doctor listed on my medical card.  *Note:  Insurance will let you see any doctor within the practice; this is a point of harassment by the PCP’s office
  • Site Supervisor calls me to tell me I cannot use an “unprofessional tone” with staff.  The tone he is referring to is a frustrated one of being harassed by his staff.
    • Surprisingly….he backed his staff
    • Accused me of being unprofessional with him; oh wait – I was frustrated at this nonsense
  • Threatened my appointment would be cut short if I was not 100% professional with his staff
  • I ended the call telling him my responses would be “yes” and “no”, said, “Good day, Sir” and hung up.

I have no rights.  Sutter Health and its providers should be embarrassed, ashamed and liable for what they are putting me (and no doubt other patients) through.  This is not acceptable and we have no recourse.  They can write anything they want in the chart.  Any complaints to the state, that’s supposed to govern them, only reads the chart and does not contact the patient for details and/or clarification.

I simply ask that people share this.  Silence is their success in being allowed to continue to mistreat, deny care and abuse patients.  Patients are allowed to say “no” and do what is in their best interest; not what’s easiest for the physician’s office.

 

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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!

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!

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!

Medical World = STRESS!!!

Published May 18, 2018 by lynn k scott

I have been patiently waiting for my medical insurance to decide whether they would allow a referral to a provider outside the network I am currently enrolled in.  They had 30 days in which to do so.  That’s the equivalent of molasses going uphill, on a glacier, during a blizzard.  I mean really, oncology referrals should take as long as possible because we’re only speaking of a human life.  Shoot…that sarcasm reared its truthful head again.

Even though I have completed chemo, I had no follow-up with my oncologist because she refuses to answer my questions without an appointment.  There wouldn’t be messaging capabilities if we had to make an appointment every time we needed to ask a simple question.  No wonder it takes weeks to make appointments these days.  Sorry, I digress.

It’s been very peaceful with the new job and not having any contact with anyone in the medical industry.  Yet, today, that peace was shattered.  I answered an 800 number.  The good thing is I didn’t have to go through their carrier’s horrendous hell of a voicemail system to return their call.  The unfortunate aspect was I had to deal with someone who doesn’t understand the proverbial, “you”.

While I am far from the best or even compliant patient, customer service representatives need to understand the tone of frustration compared to yelling.  It’s one thing to be sympathetic to someone’s plight of an insurance nightmare.  It’s a completely different to truly be empathetic.  Then, to add insult to injury, tell me I am yelling when I am merely expressing frustration.  There is no doubt when I truly begin to yell.  As my daughter puts it, “New York Mommy” shows up at that point.

It never ceases to amaze me how shocked people are when I say, “you have no idea” and then try to argue the fact with me that they do.  Unless the person that I am speaking with has filed multiple grievances, prepped their children for the “worst case scenario”, begged for help and to see a provider they can actually understand, DO  NOT tell me, “I understand”!!!  It’s unprofessional; to say the least.  Learn the difference between empathy and sympathy; they are not the same.

Am I overly “touchy” where my health care is concerned?  Absolutely!  Having been neglected after surgery, passed around to provider after provider and generally ignored when I insist on being in charge of my care and letting doctors only advise has me extremely “jaded” to most people.

Healthcare is non-existent.  Health profits is what drives today’s medical profession.  Patients die every day.  I truly believe insurance carriers AND providers are facilitators of this because if the patient doesn’t fit in the “acceptable” boundaries, they are discarded; regardless of how much assistance and/or treatment they need.  Nice to know it’s reached the call centers.  The entire system needs a course in compassion!

So ends another medical rant.  Off to pray for tolerance and healing.

The doctor will see you now…NOT!

Published February 10, 2017 by lynn k scott

No one in today’s world can question the reality that the face of your medical care has changed.  With new laws, requirements, insurance requirements and medical office billing, trying to see “your” doctor isn’t always your choice.

Whether you have a chronic medical condition or just need to be seen for newly developed symptoms, making an appointment isn’t as easy as it used to be.  In today’s world, the emergence of Nurse Practitioners (NP) and Physician’s Assistants (PA) are the new “in” thing.

“Hi, I’d like to make a doctor’s appointment”.

Seem’s like a simple enough request.  After all, most of us are pay enormous premiums and/or copays for the privilege of a doctor to spend 10 minutes with us.  That’s in addition to two or three patients being scheduled for the same time slot so the doctor doesn’t lose any money, should there be a cancellation.

“Sure, you there is an appointment with Jean Smith at 3:30.”

There you go…your appointment…WAIT!  Where was the word “doctor” to go with that name?  Ahh…did you catch that too?  That’s because in this case, you won’t be seeing a doctor; but a PA instead.

Awesome.  No, not really.  I already have issues with doctors “practicing” medicine.  If I’m going to drop $45 on an appointment that a General Practitioner wasn’t able to resolve, why in God’s name would I entrust an on-going, chronic issue, to someone who isn’t even a board-certified doctor?

I don’t have the flu and I don’t need a throat culture performed.  I need a real diagnosis, made by a doctor, that will resolve my issue; the first time around.  “Oh, sorry, there are no doctor appointments available then”.  Don’t you just love the system?

Truth be told, PAs and NAs are half the price of a real doctor.  They are in even in the specialist’s office…the specialist!  Someone who may, or may not, have done any clinical work, who is now entrusted to see, diagnose and treat you, independent of a doctor reviewing their work.

Does that leave you with the same lack of confidence it does for me?  So, what are the other options?  Urgent care…yea..seeing a doctor, at double the cost of your primary’s copay only to refer you to your primary doctor.  The emergency room.  You’re in pain.  You have severe symptoms; chronic symptoms…just go to the emergency room.  Sure all the testing will be done right then.  You’ll be lucky if you only walk out owing about $2,000 as your portion of this wonderful care provided by your insurance.

All this, because carriers and medical offices prefer using under-qualified medical personnel instead of having you treated by a physician of your choosing.  After all, it’s only your hard-earned dollar that is footing this medical nightmare, right?

Tips from Human Resources

Published November 18, 2015 by lynn k scott

I did it. The worst part of Open Enrollment is behind me. We’re only 2.5 weeks past when we should have submitted the forms for our 12/1 effective date.

Here are few tips I would tell ALL employees:

1) TURN IN YOUR FORMS ON TIME!!!
2) Open the packet when you receive it – even if you think you’re keeping everything the same!
3) Please don’t say, “I was busy”, when HR calls to find out where your forms are.
4) I know it’s confusing, but if there are 3 forms, put your address on them all! It’s ok to if HR has to complete 1 or 2 addresses, but 100+ is time-consuming.
5) When changing carriers, everyone must be submitted together. When you are late, you hold up everyone! No one gets insurance on time; including your boss!
6) ASK FOR HELP when you are confused or don’t understand the forms. I smashed my crystal ball and can’t predict the future anymore. You have to be a tad proactive.
7) SIGN THE FORMS!!!! With the changing of the laws, signatures are required. Yes, yes, you’re waiving coverage. Read the first three words again; SIGN THE FORMS!!!
8) When your HR person/staff has a glazed over look in their eye(s), make sure they are adequately supplied with coffee (and not from the Evil Empire aka Starbux)!

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