Sutter Health Plus

All posts tagged Sutter Health Plus

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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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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