Risk Managers: Deny, Defend, Investigate Pt 6

Just a few more of the items that I’ve gone thru. Think again, would you want to deal with this, when you simply were trying to get care and get some answers? This is why you want to investigate the surgeon thoroughly.

Sent: Thursday, July 18, 2013 10:28 PM
Subject: Re: Results

I don’t want to drag things out, but there are questions that have been around for months, unanswered by the group. How many questions/emails (number) do you have answered so far, is there anything that you have called/emailed that has not been addressed in 3 days by another party? What are the ETA’s on those?

Do you have a timeline from the the group HIPAA violation group? Do you have confirmation that I am not mentioned in any “secret” or nonpublicized database (EPIC or not) that “flags” me in any way, and that I am not mentioned in any computer, database, or communication other than that available to me?

What do you need from me to further your investigation? When do you expect to be completed with the first phase? I can email you on Tuesdays and Fridays to check progress.

Thank you,

Sent: Sunday, July 14, 2013 7:19 PM
Subject: Results

I had some questions for you, a couple of which (what you do and how to send record discrepancies to you) should have been answered already, that haven’t been. Please let me know this week have when you will have those answers or what has been done on the issue. It has been 3 weeks and I’ve seen no action on the group’s part.

I was placed on prednisone for skin problems. Had the malnutrition been taken care of earlier, I wouldn’t have had this problem, as skin issues are another sign of PEM. Now I’m taking a medication that we have no idea if it will mess up my stomach, due to lack of care. GI’s do not have experience in this area. My internist, who I had to produce medical documentation to get testing that was to be done in June, would not know either. This is in direct conflict with the assertion that my internist and GI could care for me.

——– Original Message ——–
Date: Wed, 19 Jun 2013 11:43:07 -0400

Good morning,

Thank you for speaking with me this morning.

One of my requests is that if there is any information regarding me and my patient care that I cannot access through electronic health record, or has not been given to me already in the doctors’ office notes, to be provided a copy of that. This does not include billing information. Please feel free to let me know the different types of information that I may not have covered in this email, as I may not need that information.

If you could also let me know the outcome of the questions I had in regards to procedures for requesting record modifications/additions, that would be helpful.

Thank you for you help.

——– Original Message ——–
Subject: Re: Information Request
Date: Wed, 19 Jun 2013 23:13:17 -0400

Good morning,

For a bit of clarification on surgery. I understand there is no bariatric care thru the group. If I was to need an appendix out, would that rule out any the group doctor? another surgeon was the original doctor I wanted for my bariatric surgery. I was refused going to him first for the bariatric surgery (just told I was to have bariatric surgeon, and that’s who I was assigned) and then that other surgeon’s office said he would not overrule bariatric surgeon’s refusal for the gallbladder removal surgery (my insurance called the office & bariatric surgeon did do the surgery). I was told something different by other admin. I have also been told that the reason I didn’t get another surgeon was that he is more of a general vs. bariatric surgeon. Several have said once one doctor operates on you, they don’t like to go in on someone elses’ work. A specific answer would be very helpful for me & to pass along to others, as I’ve been told one thing one time, a different one another time.

I’m without care now, and the contract I signed with the group was that I would return for follow up visits. If we don’t need care after surgery and can go elsewhere, then why did the group have me sign a paper stating that?

My Mother and I were told by bariatric surgeon that he would round on me the Tuesday afternoon I was in the hospital for my gallbladder surgery and never showed up. My Mom is 73 years old, and after several hours of waiting, had to drive home thru the a very congested major artery in rush hour traffic to get home. If you’re going to give me an answer, please keep it consistent.

I was told that plastic surgeon, a plastic surgeon, spoke with bariatric surgeon, then was told nothing was said, then it seemed there was conversation between them. That conversation was never in my notes, nor was there any documentation obtained on it. That is one of a number of questions I had about my care I couldn’t get answered while still a patient, or the answer would change. I’m looking at plastic surgery so if there is still an issue, I would expect to know about it.
Again, if there is any other problem or prohibition that I am missing, at least work with me professionally to find care before you throw me out. I’m having problems, my internists office told me that I had lost a “huge chunk of my care” and because of legal issues (not from me, non compete agreements?) no one else in the area will take me. After everything I’ve been through, if I can still find positive things to say about the office, please find that same spirit for me.

Thank you,

——– Original Message ——–
Subject: Re: ER – hospital
Date: Wed, 7 Aug 2013 10:15:41 -0400

Ma’am I’m talking about the blacklisting that appears to go on. I don’t want to come if we’re not going to treat me. I was recommended to go to the ER by the insurance nurse and the GI nurse. However, a PICC line is what is needed, and that would be a hospital stay. The only response I get is that my the group doctor tells me to go out of the area for care.

So I know what you say, but in practice, that’s not what is happening.

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