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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by allisonm on November 11, 2000, at 8:37:39
After reading horror story after horror story about rotten pdocs, I thought I might throw in details of what happened at my session this week.
My pdoc at the end of the hour said that my HMO was asking to see my charts from my 2+ years with my him because they are going through some accreditation process and wanted to see charts for his longer-term patients. They wanted to see ALL of my records -- including the visits that they did not pay for (they only cover 20 per year at %50). He said no and suggested they pick someone else in the practice, but they insisted on mine saying that they have a right to see them and that I signed a consent form when I signed up. My pdoc told them he doesn't think people understand what they're signing when they sign up, so would not release my records and he brought the whole issue up with me to see what I wanted to do. If we refuse, the consequences are that they could disenroll me and throw him off their board.
I was planning on switching HMOs this fall anyway to one that seems to pay its doctors on time (mine had been cutting physicians fees and delaying payments), provide its customers paperwork they request without losing the requests (this happens to me every time), and to give approvals for treatments more expeditiously. I don't want them to see my charts because it's none of their business and they're not going to be my HMO shortly so its doubly none of their business. Plus my exhusband works for that HMO and while they insist on complete confidentiality, I don't trust them.
My doctor supports me and isn't especially concerned if they terminate him too. He said if he ever interviews for another HMO, they will ask him if he's ever been terminated by an insurance company and this possible termination may jeopardize his chances, but he doesn't think that being fired for defending patient confidentiality is a bad thing.
I think I am lucky.
Allison
Posted by coral on November 11, 2000, at 18:56:48
In reply to Good pdoc, bad HMO, posted by allisonm on November 11, 2000, at 8:37:39
Dear Allison,
In my opinion, your HMO is way out of line, ethically, morally and legally. Since this is happening to you, it's a good bet it's happening to others. I'd contact your Consumers Affairs Division at your state level first. Even in a criminal investigation, a patient's right to confidentiality supercedes all others' rights, unless the patient agrees. I'd also look at the form you signed. Read it carefully. Just because you signed it does NOT make it legal. One of the nice things about the U.S.A. is that you cannot sign away rights.
As you said, good pdoc, bad HMO
Coral
Posted by ksvt on November 11, 2000, at 22:05:43
In reply to Good pdoc, bad HMO, posted by allisonm on November 11, 2000, at 8:37:39
>Allison - maybe your pdoc will fare ok if he just ignores the request. Several years ago, my insurer sent a letter demanding an explanation for why my pdoc had billed me for 3 hours of therapy in one day. (I was pretty suicidal and he got my husband in for a couple of those hours.) My pdoc showed us the kind of letter he'd have to write to respond to the request and we decided it definitely wasn't the kind of thing we wanted circulating. He redid my bill for that month to omit reference to that session and I resubmitted the claim with the new bill. Either the insurance co. didn't care as long as they were then not being asked to pay for that session or it got lost in their bureaucratic haze. Either way, neither he nor I heard about it again. The same happened with an inquiry he got from them last year requesting an explanation for why he continued to prescribe ADs for me beyond the standard period called for in their protocol. I don't think he ever responded to that request either, all as far as I've been able to tell without consequence. He's an older guy and refuses to have anything to do with HMOs. I'm sure that has limited his patient base somewhat, but I think he thinks it's the only way he can practice. Hats off to your pdoc because it sounds like there could be a consequence to him. BTW, how are you doing? ksvt
After reading horror story after horror story about rotten pdocs, I thought I might throw in details of what happened at my session this week.
>
> My pdoc at the end of the hour said that my HMO was asking to see my charts from my 2+ years with my him because they are going through some accreditation process and wanted to see charts for his longer-term patients. They wanted to see ALL of my records -- including the visits that they did not pay for (they only cover 20 per year at %50). He said no and suggested they pick someone else in the practice, but they insisted on mine saying that they have a right to see them and that I signed a consent form when I signed up. My pdoc told them he doesn't think people understand what they're signing when they sign up, so would not release my records and he brought the whole issue up with me to see what I wanted to do. If we refuse, the consequences are that they could disenroll me and throw him off their board.
>
> I was planning on switching HMOs this fall anyway to one that seems to pay its doctors on time (mine had been cutting physicians fees and delaying payments), provide its customers paperwork they request without losing the requests (this happens to me every time), and to give approvals for treatments more expeditiously. I don't want them to see my charts because it's none of their business and they're not going to be my HMO shortly so its doubly none of their business. Plus my exhusband works for that HMO and while they insist on complete confidentiality, I don't trust them.
>
> My doctor supports me and isn't especially concerned if they terminate him too. He said if he ever interviews for another HMO, they will ask him if he's ever been terminated by an insurance company and this possible termination may jeopardize his chances, but he doesn't think that being fired for defending patient confidentiality is a bad thing.
>
> I think I am lucky.
>
> Allison
Posted by S. Howard on November 11, 2000, at 22:09:19
In reply to Re: Good pdoc, bad HMO, posted by coral on November 11, 2000, at 18:56:48
My HMO, which I will not name but which goes by the initials HL, mailed a certified letter to my house saying that the medical records of my hospital stay had been reviewed by the grand poobah doctor of HL and according to him, I had never been mentally ill enough for hospitalization and they had no intention of paying for my hospital stay. My jaw hit the floor.
On the morning I was admitted, (1)I spent hours in the emergency room waiting for insurance authorization for admission and transport to another hospital approved by my HMO and (2)I had no desire to go to the hospital, so I was admitted involuntarily to a locked psychiatric ward by the pdoc on call. Now here was my HMO, acting as if I had walked up to the ward, with no prior approval, and knocked on the door and asked them to let me in.
It's been a couple of months since the certified letter arrived and I haven't heard anything more about it. Of course I don't have any intention of paying this hospital bill, and I plan on switching insurance companies shortly. -SGH
Posted by Kaarina on November 12, 2000, at 12:54:33
In reply to Re: Good pdoc, bad HMO, posted by S. Howard on November 11, 2000, at 22:09:19
One of my family members had had a heart attack. Years later had severe chest pain and high blood pressure. Was admitted to the hospital, put on morpine and had a 24hr heart monitor. Five days later nothing had showed up and was discharged.
Would a HMO send a notice saying that they would refuse to pay? Or is this just for mental illnesses?
Posted by allisonm on November 12, 2000, at 13:16:59
In reply to RE: s. Howards's response On the flip side ..., posted by Kaarina on November 12, 2000, at 12:54:33
> Would a HMO send a notice saying that they would refuse to pay? Or is this just for mental illnesses? > >I don't think it's limited to mental illness. I think they do this all the time elsewhere also. However, mental illness is harder to track/quantify results-wise, I think, so maybe they ARE pickier with us.
A little over two years ago, my pdoc also got a notice from my HMO saying "gee she's been on ADs for more than 6 months now, and we think most patients only need them for 6 mos. What's up?" Nevermind that my HMO doesn't pay for my scripts -- they are paid for by my major medical coverage, which is with another company entirely... We joked at the time, reasoning that the trials for ADs are only for 6 weeks, maybe the time limit for taking ADs should only be 6 weeks in the HMO rule book. That's probably next.
Posted by allisonm on November 12, 2000, at 13:35:27
In reply to Re: Good pdoc, bad HMO » allisonm, posted by ksvt on November 11, 2000, at 22:05:43
Thanks for all of your thoughts and ideas.
Coral's idea makes me think that maybe I could contact my state assemblyman, who is a real good guy and who also is working on improving the insurance/health care situation in the state.
I have a feeling that my HMO isn't going away, however. They have been persistent with my pdoc; I don't see why they won't be as insistent (or more) with me. They need my pdoc more than they need me. We'll see what happens. I'm kind of spoiling for a fight anyway given the hassles this company has already put us through.
To ksvt: Thanks for asking. I am OK. We changed my meds around a few weeks ago. He says my depression is chronic, which was depressing in itself for a couple of weeks. We ditched the Remeron and added Neurontin to the Wellbutrin. I've been feeling better -- laughing even, which feels weird -- but am a little afraid to admit it because I've been wrong before. Last session, I told my pdoc I wasn't going to try to guess anymore if meds were working or not. There are always two or more reasons why I could be feeling good or bad. I could have a good day and say "Hey, this Neurontin is working!" and then have a bad day the next and say "Damn Neurontin, what good IS it?" He got a little frustrated with me, I think. If this Wellbutrin/Neurontin mix doesn't work, he was going to suggest an MAOI, but I protested at the prospect of the 2-week washout and what that could do to me at work, so now he says there are other alternatives, such as Celexa. But I didn't react well to SSRIs before so I wonder. I was all set to see this Neurontin fail too, but I have felt good enough in the last couple of weeks to think it is working. I just hope it works enough and keeps working. Nothing really has so far.
Allison
Posted by ksvt on November 12, 2000, at 19:49:23
In reply to Good pdoc, bad HMO...coral,ksvt,S.Howard, posted by allisonm on November 12, 2000, at 13:35:27
>Alison - you may have actually told me this before, but what amount of WB are you taking and how long have you been taking it? Is it the SR variety? Your pdoc's frustration notwithstanding, I think it's extremely difficult to quantify how well a med is working. I've been taking differing amounts of WB for years, and clearly it works, because I'm better than I was, but I still have alot of depressive episodes (chronic like you), so there's always the thought that there is something out there that works better. I tried adding zoloft last spring, but I didn't care for the side effects and it really didn't seem to make much of a difference. I, too, have a rather unsatisfactory history with SSRIs. Each bad experience makes me very wary of making any med changes. I'd love to hear how this works for you. Thanks ksvt
Thanks for all of your thoughts and ideas.
>
> Coral's idea makes me think that maybe I could contact my state assemblyman, who is a real good guy and who also is working on improving the insurance/health care situation in the state.
>
> I have a feeling that my HMO isn't going away, however. They have been persistent with my pdoc; I don't see why they won't be as insistent (or more) with me. They need my pdoc more than they need me. We'll see what happens. I'm kind of spoiling for a fight anyway given the hassles this company has already put us through.
>
> To ksvt: Thanks for asking. I am OK. We changed my meds around a few weeks ago. He says my depression is chronic, which was depressing in itself for a couple of weeks. We ditched the Remeron and added Neurontin to the Wellbutrin. I've been feeling better -- laughing even, which feels weird -- but am a little afraid to admit it because I've been wrong before. Last session, I told my pdoc I wasn't going to try to guess anymore if meds were working or not. There are always two or more reasons why I could be feeling good or bad. I could have a good day and say "Hey, this Neurontin is working!" and then have a bad day the next and say "Damn Neurontin, what good IS it?" He got a little frustrated with me, I think. If this Wellbutrin/Neurontin mix doesn't work, he was going to suggest an MAOI, but I protested at the prospect of the 2-week washout and what that could do to me at work, so now he says there are other alternatives, such as Celexa. But I didn't react well to SSRIs before so I wonder. I was all set to see this Neurontin fail too, but I have felt good enough in the last couple of weeks to think it is working. I just hope it works enough and keeps working. Nothing really has so far.
>
> Allison
Posted by allisonm on November 12, 2000, at 21:27:39
In reply to Re: Good pdoc, bad HMO...coral,ksvt,S.Howard » allisonm, posted by ksvt on November 12, 2000, at 19:49:23
KSVT,
I have been on 6 different meds in 7 combinations since early 1998.Currently, I take 400mg of Wellbutrin SR/day (200mg in the morning and another 200 at 3pm). I have been on Wellbutrin since June of 1999. Started it at 100mg to augment Remeron. Six months later, the dose was increased to 200mg. Last March, the Wellbutrin dose was increased to 300, 350 and then 400 and the Remeron became the augmenting med, reduced over time from 45 to 15mg.
Since April I have found that Wellbutrin at 400mg has been the most effective, with the possible exception of Remeron 45mg and Lithium augmentation. I was on Rem since March 1998 and started the Li augment in October 1998. I was doing so well on Rem/Li that my doctor took me off the Li the following April, but I sank rapidly. There were too many side effects with the Li, too, so I refused to go back and was put on Wellbutrin. I still am trying to remember how well the Li worked. However, I stopped writing in my journal between January 1999 and May/June 1999 when the suicidal thoughts came back. So it must have done some good as I tend not to write in my journal when things are going well. I write copiously when things are bad.
This Wellbutrin higher dose helped but over time with the Rem augment did not do particularly well over spring and summer, so my doctor put me on the Neurontin several weeks ago. Now up to 800mg of the N (200mg am and 600mg before bedtime), I think it is the best combo so far (unless I am forgetting how well the Li worked, which I may well be doing.)
But I still am wary because nothing has really worked to the point that depression is not pretty much front-and-center in my mind most of the time. I am waiting for the day when I actually forget about it. Right now, I still am hypersensitive to my mood shifts. The Neurontin seems to have "brightened" everything pretty rapidly, at least it did once my PMS subsided. It won't touch that, but I have only been through one cycle with it.
I'm still pretty unhappy with the chronic diagnosis. It feels so permanent and lifelong. I dread the idea of going through the rest of life (I'm 39 this month) damaged, unable to see life normally the way others do, or always being susceptible to unpredictable depressive episodes for indeterminant lengths of time.
Take care.
Allison
Posted by ksvt on November 13, 2000, at 16:54:22
In reply to Wellbutrin SR » ksvt, posted by allisonm on November 12, 2000, at 21:27:39
>Allison - thanks for the rundown. My therapist and pdoc don't throw alot of technical terms around, but I have been forced to admit that mine too is a chronic condition. Thinking about it in those terms can be very discouraging. I try to convince myself that if I learn to handle the stressors and restructure things to get rid of some of the stressors, it can make a real difference to the incidence of depressive episodes. I don't know this to be true because I haven't gotten great control over this yet. However, I do know that if I can't feel that way, life really does seem overwelming. Therefore, and strictly speaking for myself, it seems to help me not to globalize this or to think long range. WB (I take the regular variety) has made such a difference to me but I have never been anything other than a partial responder. I admire you for plugging away at trying to find a better combination. I get easily spooked by drug changes so I'm not proactive about this at all. I think sometimes we learn to live with a higher degree of depression than we need to, and its hard to remember or see that you don't necessarily have to feel this way. Thanks again ksvt
KSVT,
> I have been on 6 different meds in 7 combinations since early 1998.
>
> Currently, I take 400mg of Wellbutrin SR/day (200mg in the morning and another 200 at 3pm). I have been on Wellbutrin since June of 1999. Started it at 100mg to augment Remeron. Six months later, the dose was increased to 200mg. Last March, the Wellbutrin dose was increased to 300, 350 and then 400 and the Remeron became the augmenting med, reduced over time from 45 to 15mg.
>
> Since April I have found that Wellbutrin at 400mg has been the most effective, with the possible exception of Remeron 45mg and Lithium augmentation. I was on Rem since March 1998 and started the Li augment in October 1998. I was doing so well on Rem/Li that my doctor took me off the Li the following April, but I sank rapidly. There were too many side effects with the Li, too, so I refused to go back and was put on Wellbutrin. I still am trying to remember how well the Li worked. However, I stopped writing in my journal between January 1999 and May/June 1999 when the suicidal thoughts came back. So it must have done some good as I tend not to write in my journal when things are going well. I write copiously when things are bad.
>
> This Wellbutrin higher dose helped but over time with the Rem augment did not do particularly well over spring and summer, so my doctor put me on the Neurontin several weeks ago. Now up to 800mg of the N (200mg am and 600mg before bedtime), I think it is the best combo so far (unless I am forgetting how well the Li worked, which I may well be doing.)
>
> But I still am wary because nothing has really worked to the point that depression is not pretty much front-and-center in my mind most of the time. I am waiting for the day when I actually forget about it. Right now, I still am hypersensitive to my mood shifts. The Neurontin seems to have "brightened" everything pretty rapidly, at least it did once my PMS subsided. It won't touch that, but I have only been through one cycle with it.
>
> I'm still pretty unhappy with the chronic diagnosis. It feels so permanent and lifelong. I dread the idea of going through the rest of life (I'm 39 this month) damaged, unable to see life normally the way others do, or always being susceptible to unpredictable depressive episodes for indeterminant lengths of time.
>
> Take care.
> Allison
This is the end of the thread.
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