Referrals Clerk Incompetent

Over the last year, my husband and I have needed a lot of referrals.  I now have major frustrations over the process.  Every time I call the doctor’s office, they tell me it’s “in process” or they’re waiting on the insurance company.  Most recently, the insurance company told me the doctor’s office simply needs to fax the referral to the clinic they’re referring to as the insurance company only needs to pre-approve procedures.  The specialists consistently tell me they didn’t receive the referral so they can’t make an appointment. 

My husband has had multiple ER trips since March 2018 for kidney infections and he’s been on antibiotics numerous times.  It took months before our “doctor” put in a referral to a urologist even though my husband has a rebuilt bladder and was complaining about feeling like he had an infection.  The local hospital urology clinic had two providers, both claim his case is too complex for them.  My husband got a referral to a doctor in the next town who said he could handle my husband’s case then won’t because he doesn’t take his new insurance. I called the doctor’s office and advised we would prefer a urologist in the next state over as it is less than 2 hours away from our home and a straight, easy drive.  The doctor’s office sent his referral to a doctor who is 3 hours away from our home and in the mountains where it’s snowing. 

Early January my husband was having another bout with a bladder infection.  He was miserable: puking, clammy, unable to eat or drink or keep his pain medications down.  He was in tears.  I was enraged.  I called his doctor’s office and explained he needs a referral to a urologist, podiatrist, and some kind of referral for the pain in his shoulder and back.  I explained to the person who answered the phone that this is becoming a mental health crisis because Miss Melissa is not doing her job correctly and my husband is not receiving the care he needs.  I explained he DOES NOT need a referral for pain management as he’s already being seen by a doctor for that.  (Twice I’ve explained he needs a referral for diagnostics for the new pain in his shoulders and back.  I explained the metal rods in his back have shifted.  I explained if he’s referred to another pain management doctor he can be fired-TWICE they ignored me and sent pain management referrals.)

Miss Melissa hadn’t returned my calls but when I called and she was there, the receptionist patched me through.  Miss Melissa told me she was confused and had left a message-true.  She also claimed to have left a message advising a referral had been processed and my husband just needed to call to schedule an appointment.  That was a lie. 

Miss Melissa argued with me about what the insurance company said and told me the referral has to be approved by the insurer.  I asked her why they would lie to me.  She finally agreed to fax the referrals to the specialists the same day, then she didn’t do it. 

I called and left a message for Miss Melissa’s boss advising she either needs to be fired or retrained (I’ve never done this before in my life).  I’ve also left 3 messages for her boss asking for a call back and not once has she called back. 

My husband has an appointment with a podiatrist coming up but he went through his pain management doctor to get x-rays ordered to diagnose what’s going on with his shoulder and back. 

After an ER visit, I called my doctor’s office and requested a referral to a urologist and a gastroenterologist.  The referral for the urologist was sent to a clinic 3 hours away.  Apparently Miss Melissa thinks my husband and I have interchangeable health needs.  I’m still trying to make contact with the gastroenterologist as they didn’t have my referral from my doctor’s office the first time I called. 

Yesterday, my husband received a letter from the “referral clerk” at the offices of our primary care physician reporting that his referral for Neurosurgery had been sent.  My husband has not been advised by any doctor that he needs a referral for Neurosurgery, so this letter is unexpected.  I have been seeing a neurologist since November of last year, so more than 3 months.  It would seem Miss Melissa has erred again and I needed the referral more than 3 months ago. 

We’re considering switching doctors but what we’re hearing again and again is it’s like this in most doctor’s offices in this community. 

Shame on you for treating people as if you don’t care if they suffer or survive!

The Princess and the Pea

I woke up Saturday morning feeling like I needed to pee right now! So, I did. 30 seconds later, I felt the urge again. So, I did. (I’m getting older.) And again. I realize something is off and I’ve had urinary tract infections (UTIs) before and even two kidney stones over the years. I ask my husband to pick me up some cranberry juice before he heads out on his adventures for the day.

I’m thinking if I’ve got a UTI and I’ve caught it early, the juice will do the trick to eradicate it. However, I remember the urologist told me to avoid masking my symptoms with juice like I did with my second kidney stone (nasty infection).

I go about the day with minimal discomfort.

I was sick as a dog that night. I didn’t want to go to the emergency room because I wasn’t dressed, my hair was dirty, and it’s the emergency room. Oh yeah, and I was on my belly, on the floor, fighting my way through and praying for the urge to push to stop. I was terrified I was going to push my insides out! I threw up. Eeeeew!

I woke up Sunday morning feeling okay. Just sore in every muscle in my body from the tension from the night before. The feeling I needed to pee was back. I drank more cranberry juice and water. I talked to my husband about my indecision about whether I should go to the ER or not. I showered. We both got ready, just in case. I felt a pain on the left side of my stomach area and was starting to feel pain in my left flank. I knew tests would be needed to confirm if it’s a stone and that can’t be done at Urgent Care. I knew I’d have to call early the next morning and wait on hold for more than an hour to find out if my doctor had a same day appointment and she wouldn’t be able to do the tests needed to confirm if it’s a stone. I definitely remember the pain I experienced with the first two stones and would rather not repeat. I’d rather give birth to another child. I opted to go to the emergency room.

The admitting nurse was so thoughtful when she arranged a room where I wouldn’t be seeing people pass through the hall, as that could have triggered my vertigo. While waiting, I drank 16 ounces of water so I could produce about 3 ounces of urine for testing. I was wheeled into radiology for a CT scan of my abdomen and gave me a warm blanket before returning me to the ER. The doctor came in and did an examination and asked quite a few questions. He asked if I’ve been diagnosed with diverticulitis (I have but am asymptomatic). He asked if I’ve had a colonoscopy (3 years ago when they told me about the diverticulitis). He asked if I have high blood pressure (no). High cholesterol (I take fish oil and niacin)? He left and returned a bit later to tell me there’s a lot of blood in my urine, I have a 4mm kidney stone in the ureter just above the bladder, there’s a cyst on my kidney, and the juncture of my small and large intestines appears to be thickening. He prescribed Flomax and Ibuprofen. The Flomax is to loosen things up in there so the stone can hopefully pass. He told me to follow up with the urologist.

A baby green pea is approximately 5mm. This stone is 4mm and covered in pointy spikes like a goathead thorn.

I’m taking the Flomax and I picked up some over-the-counter Azo for the urgency. The Azo made my urine very, very, very yellow! Cheerful.

I will be calling my doctor to request referrals for the urologist and gastroenterologist later today. Experience tells me to expect it to be months before I’ll be seen by either.

I’ll keep you updated.

Prescription Insurance Confusion

Earlier this week, we went to my husband’s favorite pharmacy to pick up his pain management medications.  The pharmacy tells my husband someone else picked his meds up earlier in the day.  Our sister-in-law beat us to the pharmacy.    

We find out later from our sister-in-law Marie, she paid $465.26 for the prescriptions. My husband was expecting our co-pay to be around $40. She said the pharmacy told her they need a copy of his new insurance card. He was frustrated because he had taken a copy of it in the previous week when he received it. There was even a copy of the card in the bag with the prescriptions. He was sure there was no way to get the money back. This is a huge deal because our monthly income is less than $650.

I called the pharmacy to tell them my husband has prescription coverage, a copy of the card was in the bag with the prescriptions, my sister-in-law paid for the prescription and at $465.26 there is no way the insurance was applied.  She told me the new card he provided was showing it isn’t in effect until 2/1/19.  She stated she would contact the insurance company and call us back.

I called the number on the new prescription card, the woman who answered told us to call the number on the paperwork we received indicating we’re going to receive help on prescriptions through 1/31/19.  I called that number and discovered there are two different programs and the one that’s in effect until 1/31/19 has a “card” that is a representation of a card on a regular sheet of paper in the letter they sent.  She explained we need to ask the pharmacy to rerun the prescriptions with the information for the current coverage and if that doesn’t work, we can fax in the receipt for reimbursement in 30 days.  She laughed and indicated she receives calls like this frequently. I called the pharmacy back but the person we were working with is on hold with the insurance company.  She’s going to call us back.

We hope.

Well, she didn’t call us back, but my husband went in today with a copy of the temporary prescription insurance card and a copy of the receipt. The pharmacy reran it with the correct information and our sister-in-law was refunded her money.

What can I say? We’ve received so many letters from the same places, we simply didn’t realize there were two different coverage plans. Sorry! Super thankful this was a mistake on our part that could be corrected easily and quickly.

Are we the only ones confused?

4 1/2 Hours to Get Blood Drawn

Left the house at 10:30 to get my blood drawn for the neurologist. Receptionist at my doctor’s office where I normally go politely explained due to a recent change in my insurance, I now have to go to one of two other locations in town. Sweet of her to tell me so I didn’t have to look it up.

My husband and I had prior experience with both labs and chose the one which seemed to be more respectful of it’s patients and their time. It’s inside a Safeway grocery store. I thought it was immediately inside one of the entrances. It was not. It was at the back of the store. I hadn’t been inside a grocery store since mid-August. The lights, sound and motion there triggers my vertigo.  

I had to traverse long distances with nothing sturdy to use for wall walking to get to the lab. The waiting area is the width of a hallway with 11 chairs lining either side and all but one seat was filled. The receptionist asks if I’ve checked in. I haven’t. She snippily tells me to check in at the kiosk.  I comply, then ask about how long the wait currently is since my husband is waiting for me in the parking lot.  An hour.  I communicate this to my husband so he can go do errands without me.

I read on the door that appointments can be made at their website.  I use my phone to set up an account for future draws.  I notice there are about five appointments still available today.

I attempt to schedule an appointment at the VA Clinic.  I try to set up an account but my username is too long.  I shorten it.  It’s being used by someone else.  I change it.  I receive a message that I cannot set up a new account because there’s already an account set up in my name! 

The receptionist calls my name and asks for my insurance card.  I explain I haven’t received an insurance card from CareFirst yet.  I’m not concerned because I’ve had two doctor visits since 1/1/19 and they both had my new information.  She tells me she has to make a copy of the card.  I explain again they haven’t sent me one.  She tells me they can’t draw my blood until I have my card.  I’m pissed but I feel so stinking bad, I don’t even argue, just leave.   

My husband shows me his CareFirst card and says it was in the paperwork he was looking at the day before.  I ask if mine is there too, he says yes.  I snag a same day appointment at 2:15 using my new account.  We go get lunch.  I leave another message for the local VA Clinic requesting an appointment.   

We go home to get my new insurance card.  It’s not on the table.  I tell my husband I can’t find mine.  He thought I received a separate mailing with my card at the same time his came in the mail.  I did not.  I call CareFirst and explain what’s going on.  She tells me my card should arrive by 1/20/19 and until then they cannot send another one.  I explain the lab won’t take my blood without the card and I can’t see my neurologist again until I’ve obtained all the tests he ordered.  She puts me on hold, talks to her supervisor, calls the lab and tells me the lab must take the blood draw whether or not I have insurance and all I have to give them is my AHCCS number, I tuck the 18 page letter with the number in my purse and thank her profusely.

I call and schedule an appointment for my husband to see a local urologist in 2 months.  It has taken more than 3 months to get this referral!  We haven’t received the referral for the podiatrist yet. 

Called and scheduled my annual mammogram and a sinus x-ray for the same day. 

Called and confirmed my appointment for a mental health exam which Disability set up.  Tried to call Disability to confirm appointment, they didn’t answer. 

Went back into Safeway using a cart to steady myself as I went back to the lab again.  Had my blood drawn after 2 other people were called before me even though I had an appointment and they didn’t.  It took from 10:30 to 3 pm for me to get a blood draw today.  

Finally connected with the VA Clinic and got an appointment in 8 weeks and have to give them a blood sample in 6 weeks.  Hope the next one doesn’t take as long!

Dashed Hopes for Vertigo Solution

Ugh! I need to write about this but I really don’t want to because there’s a part of me that believes by talking about it I’m focusing too much attention on it and inviting negativity into my life. I don’t want to deny it’s happening either. I guess I’m hoping that if I don’t talk about it, it’ll go away. It could go away as quickly as it started. 

I have vertigo. I don’t know why it’s happening or how to make it go away. I was a “normal” person working a “regular” job until mid-August 2018. In a way, it feels like karma because I have worked since I was 11 years old and have always harshly judged people who claimed disabilities I couldn’t see this. If you saw me, you probably wouldn’t realize I have an issue as I’m using coping skills like wall walking and using something on wheels to stabilize me as I walk. Some of my triggers are: light, noise, and commotion.

I am dizzy more often than not. The dizziness causes me to be nauseous most of the time. I’m also constantly trying to compensate for the feeling that I’m unbalanced which is physically and mentally exhausting. I’m frequently mentally confused now. I’ve tried exercises and medications. I’ve stopped medications hoping it was a side effect that developed over prolonged use. I’ve had a bunch of tests and seen a lot of specialists.

I had an appointment at my neurologist Dr. George Frazier.  His office is located an hour away from where I live. This was a follow up visit to my first visit with him in mid-November. He had asked for some tests to include an MRI, blood tests and an ultrasound and left me feeling he was confident in his ability to figure this out.  I had done the MRI the morning of my appointment with him at the request of my Nurse Practitioner Samantha Tulare. I did the blood test within a week and the ultrasound within two weeks. I don’t drive right now so I have to rely on others for transportation.

Yesterday, my husband and I arrived on time and waited 45 minutes to be seen. The doctor came in and asked me “What bothers you the most?” I had no idea what he was asking. I tried to figure out what I could ask to clarify what he wanted to know but didn’t feel successful at all. He asked why I hadn’t done an MRI, I explained I did the morning of our last appointment. He told me I’d had an MRA not an MRI and they’re different. I told him a hospital employee told me they were the same thing when I called to make the appointment. That was wrong and he seemed upset with me for not knowing better. He said I need VNG and I reminded him I had that done by an audiologist. He stated he needs results and I asked if he wants me to get them and bring them to him.  Yes (glad I clarified or he wouldn’t have them for next appointment either as I thought doctors’ offices gathered this type of thing. Isn’t that the purpose of signing authorizations to release medical records? He asked why I haven’t done the EEG, nerve conduction tests, etcetera. I explained his office had called and said they were waiting on approvals from Blue Cross Blue Shield and they would call back when obtained and they never called back.

I knew some tests hadn’t been done but didn’t consider rescheduling yesterday’s appointment because I did the blood tests and ultrasound and was hoping the answer lay within those results so the others weren’t necessary. Dr. Frazier seemed quite upset with me for not doing something different. I’m not a doctor. I have no medical training beyond first aid training in basic training. I was emotionally crushed.

My husband, William, let me vent my anger, frustration and disappointment the rest of the evening. He’s such an awesome partner in life! I was angry for being held accountable for things beyond my understanding and responsibility. I’m frustrated by the medical community in this part of the country. I’m disappointed at still not knowing why the vertigo is happening or how to stop it.

I want my old life back and I get my hopes so high when I think a doctor has identified the cause or I have a few good days in a row. It hurts so much when I’m wrong.