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Tuesday, June 22, 2010

Mama Bear Is Striking Back Again. Compliance Dept., Here I Come!

As mothers, many of us possess this uncanny gift. We call it Mom-dar. With this gift we can sense things from a mile away (it seems) that just feels "off". Be it about a place, a situation, or even a person.

And for me, my Mom-dar was right on target that day, but I couldn't place why. I knew the who. But for what reason?

Well, as of last night I now know the why, to go along with the who.

Many readers know that I had a lot of problems obtaining Bryce's Intuniv. I was able to get samples. But the going in every one to two weeks was getting to be a real hassle. And of course, it didn't help the doctor (once again) was on a month-long leave when I needed him for the Pre-Authorization process.

Being the doctor in charge of Bryce's care was gone, another doctor who in fact is over the other doctors in the practice is to pick up the slack and help with prescriptions (if they are established) and pre-auth's.

Not the Office Manager! And believe me, he SUCKED! Yes, it is a male head Office Manager/Nurse. Gender is not the issue. The ability to perform duties, and get the IMPORTANT matters taken care of in a TIMELY manner are the issues.

The one nurse that DID help us by taking charge when I came in crying and finding lie after lie had gotten more done in TWO DAYS than the idiot did in (almost) a month.

After all was said and done, I made formal grievance complaints against the Office Manager, and then called insurance and filed one with them as well. The lady in Compliance for the Doctor's Building was pretty upset and took care of it all right away. She even apologized to me (though I told her it wasn't her place, and nothing was her fault).

Last night, I had gotten a call. It was from the nurse that HELPED me and my son. I found out this happened to more than just us. It happened to a few families. And I was not the only one to file a complaint. A few of us did.

And our beloved nurse got FIRED last week because of it all. Because she stood up for us and our kids. Because she voiced herself over what she was seeing. And because she could EASILY get many in that building fired...

Though the office manager (if you want to call him that) claims he is going nowhere and that he has friends in "high places" to ensure his stay. And he has been REPORTED on several occasions for various screw ups and "no call, no shows" to work. He comes and goes as he pleases. No consistency in the office.

She was fired based on "aggressive communication" and for "overstepping authority". In other words, she got somewhere with insurance by playing their game back with them and got somewhere, where as the one appointed to do so, didn't do a damn thing and it made him look bad.

I've done it once, and I will GLADLY do it again. I am calling Compliance to file a grievance on my fave nurse's behalf. And writing her a Letter Of Recommendation. Plus I found out from the "birdie" that my other favorite nurse (that knew what the hell she was doing) was 'pushed out' by the Office Manager because he didn't like that she could run circles around him and do HIS job and her's 110% better than he ever could.

Sometimes, I hate men. Especially the egotistical, narcissistic, asshole types.

Off to start my busy day of calls and (maybe) taking a kid to the doctor due to an allergy problem and a (possible) ear infection.

1 comment:

singedwingangel said...

Have you thought of also filing a complaint withthe medical board as well.. and contacting thenews

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