Sunday, September 10, 2017

Disruptive Women



I periodically check out an organization called Disruptive Women in Healthcare to see what's going on.  Despite the fantastic name, it looks a tad too corporate/non-profitty for me (that's how disruptive I tend to be), so I've never looked into joining it. Anybody out there on the interwebs who's a member of Disruptive Women in Healthcare?

I'll show you disruptive.

I think Sophie's name and persona is being used for MediCal fraud. This weekend I got a stack of papers, including 5 Explanation of Benefits for services rendered three years ago on arbitrary dates for arbitrary amounts of money. The provider is The Department of Children's Services. The insurer is HealthNet. The dates were all in the fall of 2014, and we did not go to a doctor on any of them. We've never used HealthNet, although straight MediCal might have once. The Explanations of Benefits came in a big packet, each one followed by the exact same sequence of nine pages with language translation information and my "rights." That was 45 pieces of paper in the envelope, only 5 of which were the actual business at hand. Bear with me.

Don't be disruptive. Just listen.

Because it was Friday, and because I am disruptive, I decided to call the number on the sheets of paper and ask what the hell was going on. I spoke to four different persons in nearly two hours -- let's say their names were Rhonda, Wanda, Larry and Jill. Rhonda was the quickest to bump me off to Wanda who was the type of service professional you can imagine staring at a Service Manual and reading the script best suited for Disruptive Women. Whenever I said "thank you, Wanda," or "Ok, Wanda," she said, "No! Thank YOU!" and we might have gone back and forth for hours with pleasantries if I weren't so disruptive. I won't even tell you how apologetic she was every time she put me on hold and popping back in periodically to make sure that I was all right. In the end, Wanda sent me to Larry who -- quite literally -- FREAKED OUT. When I explained my "problem" to him for the second time (the first time, he kept insisting that he was trying to help me but kept asking me really stupid questions, so I admit to being impatient), in my most disruptive voice, he said, "Whoa, whoa, whoa. That sounds like something really big. Really big." Larry was undone and advised me to call the Ombudsman. He said Ombudsman in a tone of voice that conveyed the mystery of The Wizard of Oz and then, very, very solicitously spelled it out for me. Because I'm disruptive (and perhaps a teensy tinesy bit stressed), I actually interrupted him at that point and said, Larry, I KNOW what an Ombudsman is and how to spell it thank you very much. Larry and I said our good-byes, and at  approximately 4:54 pm, I called the number Larry gave to me and spoke to Jill who got a gold star for even picking up the phone so close to closing time and then after the first explanation sighed and said that I would have to call the fraud department of MediCal on Monday morning.

Are you still reading?

I put my finger to my temple and did a Rodin pose and then recalled a similar stack of papers that I received earlier in the year or maybe last year with a whole lot of weird amounts of money paid out. There was one in there from 1999, when Sophie wasn't even a recipient of MediCal, so I called then and reported "fraud" and maybe even wrote a post on the old blog about it. Because I'm a disruptive woman in healthcare and mighty efficient, I pulled out that stack of papers and found my notes. Needless to say there has been no follow-up, and now I'm facing a Monday morning call to the Fraud Department.

The most disruptive thing I'm thinking at this point is who would want Sophie's medical identity, anyway? What would be great is if we could just switch with someone healthy milking the system and really go to town on the amazing benefits.

16 comments:

  1. Hellfire! Love Maggi

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  2. Ok. This is a way to seriously reply- but fraudulent providers want to claim they cared for Sophie. There is far too much fraud occurring in Medicare (and Medicaid! ) Do you want me to put you in touch with a fraud expert? Msybe my friend can connect you with someone who really cares.

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    1. Way too serious a reply! And I actually can put you in touch with someone. There's far too many scammers and unfortunately some are health care professionals. It pains me to say it; but it makes it bad for everyone.

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  3. Good grief. I had no idea that was a thing. Sounds like my correspondence with insurance company reps and receptionists, only it was Melinda, Diane, Tisha and Laura.

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  4. Good grief. Bureaucracy! I hope you (or they) get to the bottom of this.

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  5. What the actual fuck?

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  6. Because you don't have enough time already spent on the phone with legitimate calls regarding care for Sophie.... For fuck's sake. I'm so sorry you have to deal with this, and I wish that the punishment for the person who perpetrated the fraud was to pay for Sophie's care (in a kick-ass, comprehensive way) for the rest of her life. Good lord. Put on that tutu and get ready for the high wire this morning, huh? Sending love your way.

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  7. Sending love to you and Sophie. Phone experiences like yours qualify as nightmarish. Yep.

    Thank you for introducing the concept of Disruptive Women in HealthCare. I've been looking for a way to be a voice for an invisible population of women (low income, disabled, retired, widows of military spouses) in healthcare who are not corporate or nonprofit-related and are on the bottom rung of the healthcare world. We are doing well if we can earn minimum wage for our efforts. I have yet to make minimum wage. If I didn't have a Social Security check, I would be deep in poverty. Many of us have no other options for employment because of disability, age, or living in isolated areas of the United States where are few job opportunities. We are the subcontractors who do medical transcription and medical transcription editing of hospital and clinic medical records for major hospitals throughout the United States.

    I looked at the photos of all the women identified as "Authors" on the Disruptive Women in HealthCare website and read about the ones that I felt particularly curious about. I wonder if that website would include a photo of me and allow me to address the healthcare system issues that are a daily part of my life, if I wrote a email to them about my willingness to be disruptive in my arena of healthcare.

    Perseverance furthers. A friend of mine and 5 others were willing to be disruptive and cross a line as a statement against nuclear weapons this year. She inspired me to do what I can do. All we can is all we can do. Why not? Thanks for being present.

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  8. I found myself in similar situation some years ago and it did not go well. Insurance took back their payments, but the non provider then billed me for the services never done, saying the bills were late. Went on our credit report when we refused to pay and contested that any of the things were done it took years to clear up and frankly, not worth it to me to have set things right. Cost was heavy on stress and other consequences, and offenders were not investigated. Insurance simply rescinded their Payments and did not look any further and then it was my problem at i time when I was not dealing well with things as it was.

    I hope it goes more smoothly for you and that these does lead to a fraud investigation.

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  9. Well, shit and fuck and all the other curse words out there.

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  10. Alas, Fraud of The System isn't taken that seriously, tho' I still continue to report it anyway, as you have, in hopes that perhaps someone might take it seriously since in fact it IS a serious issue and a disservice to all who rely upon the Benefits legitimately!

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  11. Oh, you need this. Wow. Unbelievable.

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  12. In addition to a fraud specialist, how about the press? Especially since this is the second time it's happened to you. Maybe a good journalist would like to grab hold of this story.

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