reform

All posts tagged reform

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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Need an Ativan just to go to the Doctor

Published March 4, 2015 by lynn k scott

I make no bones about it…I DESPISE AND HATE the medical profession with a passion.  I am not tolerant of red tape.  I speak and expect to be heard.  If I am seeking medical attention, than it’s absolutely necessary you sit up, push up your glasses, be prepared to take accurate notes and offer a solution.  Me seeing a doctor is the equivalent of a making an emergency room visit. It can’t wait and before you suggest me visiting the emergency room, I need to feel as if death is imminent to think about the amount it will cost me at the 7-11 of the medical world.  As if charging $6,000+ for a saline solution IV is acceptable ANYWHERE! (Note:  I was actually charged that two years ago).

With all the “lovely” healthcare changes, my company, which is a good one, had to make some changes to be “in compliantce” with these new mandates.  If you haven’t already been able to tell by the tone of this post, “healthcare reform” is not a topic I think has been resolved or remotely addressed, esp. by the idiot who’s name it bears.  Sorry; I digress.

Back to the issue.  My company goes with this new insurance carrier who has their own plan.  Needless to say, we’re starting month three of with this carrier and contracts have yet to be signed for certain counties.  Services are virtually non-existent.  I use the list of providers that was given to us, only to find out, it’s actually insufficient, as the majority of the providers, not even in my county, aren’t available and needs to be “updated”.

I have to hand it to the carrier’s customer service skills. They were nice enough to tell me where I could find an Internal Medicine doctor:  Fresno.  From where I live, that’s a FOUR-HOUR DRIVE!  Needless to say, the customer service representative didn’t quite care for me raising my voice and asked what was wrong with her for even making that suggestion.

Since I’m on my medical-bashing roll, let’s talk about the new trend of Nurse Practitioners.  I am not a fan of dealing with ONE, not a clinic of, but ONE doctor who is practicing medicine.  You actually think, that there is some cosmic influence that would make me actively seek out a Nurse Practitioner who is playing doctor.  Somewhere, someone thought….”Hey I know!  We are going to have a huge influx of people seeking medical treatment.  I don’t want to give up my golf-game and actually work more than two days a week, so let’s give a nurse the power to write prescriptions.”

Seriously?  Doctors miss stuff all the time and they’ve gone to school to become “educated”.  I’m not a fan of taking medicines, unless there is no other alternative.  To expect people to see a script-writing nurse is absurd.  Sure a doctor is in the office if she needs assistance.  Great…I’ll speak to the doctor directly then.

I guess I miss the days when you saw the same doctor, they knew your name, they didn’t quickly skim your chart and cover all your issues in 3 minutes so they could move on to the next patient, because they purposely book more than one person for the same time slot.

I don’t do clinics.  I’m not a number.  I speak to real people and I won’t answer a series of questions just to book an appointment.  Oh it’s policy that I answer them because my doctor has deemed them necessary?  Oh did you really just ask me if I was pregnant?  Hmm, if my doctor deems that question necessary and he/she doesn’t know the answer already, there’s a problem.  I’ve had plans that worked that way.  I answer “no” to every single question.  Later when making the appointment, I’ll contradict myself and say I have “so and so issue”.  They nurse then says, “but you said no to that question”.  To which, I simply would say, “I told you I would.  I don’t do surveys to make an appointment”.

So now, here I wait, hoping my broker can fix the non-provider issue while the carrier removes its collective head from it’s collective ass and does what we’re paying a small fortune for them to do. After all it’s only been 4 months since we elected this plan and it’s been a full 60 days active.  I’m done playing nice.  And in case you’re wondering, where the medical profession is concerned, this is me being extremely nice; cuz you ain’t seen nothin’ yet!

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