25 July 2006

Kaiser lies, lies, lies

Here's a list of what the Denver, Colorado Kaiser Permanente's customer service department has lied to me about, so far. Keep in mind, we have been members of Kaiser for less than a month.
  1. In my phone call with Stacy, I was told that the two medications I take, Synthroid and Lactocal-F, were on Kaiser's formulary. They're not. The generic for Synthroid, levothyroxine, is in their formulary, but the brand name is not. Since my previous forays into taking levothyroxine in an effort to save a few bucks backfired badly (my TSH went from 0.01 to 7 in the space of a month and a half), taking the generic is out of the question.
  2. In my phone call with Stacy, I was told that our $15/$40 drug benefit meant that there was a $15 copay for drugs, or $40 for a three months supply. It turns out Kaiser did away with their three month plan last January, and the $15/$40 drug benefit is $15 for generic, and $40 for name brand. When we planned our flex dollars, we budgeted both my medications (which aren't going to be covered at all, let alone at the $15 rate) and any prescriptions for Boo's ear infections at the $15 rate instead of the $40 rate. This is probably going to cost us a couple of hundred dollars.
  3. In my phone call with Stacy, I was told that Kaiser had 24-hour urgent care at the Exempla Good Samaritan hospital. I think having 24-hour urgent care is pretty imperative when you have two small kids, especially when one has a tendency toward ruptured eardrums. There's no 24-hour urgent care at Good Samaritan - their after-hours care is only from 6:00 to 10:00 pm, and they triage quite a few of their problems to the ER. How did I learn this? See point #6.
  4. In my phone call with Stacy, I was told there was no charge for meet-and-greet appointments to find a physician. This is the case with pediatricians, but not with family practice doctors. With family practice doctors, you pay the copay - even if the doctor is more interested in her computer than she is in your symptoms, and feigns knowledge of your medical conditions even though it's obvious that she doesn't, for instance, know what a normal TSH level is, or how to help a mother keep breastfeeding when her milk supply is drying up (Dr. Sarah Goldberg).
  5. When I called to set up meet-and-greet appointments for the family, Rich and I decided to find him an internal medicine specialist because of the undiagnosed pain he's had for years. I was told by the customer service rep I spoke with that it would not be a problem for me to set up a visit with an IM in my name, and interview the doctor for my husband if he wasn't able to make it, since he works downtown and the clinic is by our house - a drive of up to an hour from his work in normal traffic. I showed up for the visit, and was first told that Rich needed to sign a HIPAA form before I could see the doctor (Dr. Gauri Aggarwal) for him. After the customer service rep faxed the form to the wrong number, and we finally got it signed and faxed back, the doctor refused to see me.
  6. I called yesterday at 12:32 to set up an appointment for some female pain and fever. Kaiser has a department specifically for female advice, appointments, and concerns. I was told that everyone was out to lunch but that I would be called back when they returned. At 3:30, I still had not received a call back, so I called and was told that there was a four hour window that they considered an acceptable time period for a callback. At 4:35, I received a call back and was told that I couldn't be seen that day, but that my symptoms warranted a visit to Urgent Care. I was told that if I had gone to the Westminster clinic during the day, they have an Urgent Care facility there, but that it closed at 6:00 pm. I asked where the nearest Urgent Care facility that had evening hours was, and was told that it was at Arapahoe and Holly - an hour's drive in the middle of the night, and more like an hour and a half during the hours the facility is open (6 to 10 pm), or I could go to the Rock Creek Good Samaritan hospital, at 200 Exempla Circle (this is directly from my notes), and their ER also triages to after hours care. A person representing herself as a nurse supervisor called back about 15 minutes later and offered to make me an appointment for the next day, but considering how much worse I felt from 12:00 to 4:00 I decided to go on in to urgent care and fork over the extra $25 for an urgent care visit, and the 'nursing supervisor' agreed that I needed to be seen ASAP. I went to Good Samaritan's ER, told the front desk I was there for an urgent care visit, and also told the triage nurse that I was there for an urgent care visit. I didn't find out that I had been triaged as an ER patient until after they were done with the pelvic exam, which means I was stuck with a $200 ER copay instead of a $50 urgent care copay. Apparently Good Samaritan NEVER triages anything requiring a pelvic exam as an urgent care case. After calling Kaiser back today to find out why I was sent to a facility that doesn't treat female issues as urgent care, I found out that the person who I spoke with on the phone at 4:30 wasn't even a nurse, she denies giving me directions to Good Samaritan or to the facility on Arapahoe Road, and she claims that the person I spoke to at 4:45 is not a nursing supervisor. A customer service rep also informed me that there is no daytime urgent care at the Westminster Kaiser clinic. I can't seem to get a supervisor on the phone, and so far I'm not getting calls back. I'd really like someone at Kaiser to listen to any phone recordings of my calls yesterday, but the not-a-nurse who directed me to Good Samaritan claims that, despite their message that all calls are recorded for quality control purposes, there are no recordings to review.
There have been a few bright points in our road trip to Hell with Kaiser - Dr. Susan Merrill seems definitely interested in clearing up Rhys's ear infections and getting him speech therapy if it is deemed necessary. Dr. Michelle Glasgow seems to have a good understanding of hypothyroidism - she even told me something about bone loss and hypothyroid treatment that I was unaware of, she is willing to maintain my TSH at a level where I feel good, and she seems very supportive of our decision to breastfeed WeePeep (Mudbug's current moniker) through next winter to minimize the likelihood of ear infections. I'm not sure a couple of good doctors, surrounded by a morass of incompetency and bad information, is going to be enough to make Kaiser Permanente an insurance plan worth keeping.

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