It took me five months to see an oncologist from Fallon who ran my 2013 Medicare Advantage plan. In 2014, I switched to Blue Cross Blue Shield’s Value Advantage PPO. It came as a blast of clean air. Life has been so much better ever since. Not perfect, but better.
Still, this is a story worth retelling because although the names change, the same situations recur. Right now, I’m going through a similar snafu with the Commonwealth of Massachusetts. It has me convinced that my state is run by morons. Garry says I’m being unfair to morons.
This story had a beginning and an end. It started when, in November 2012 I gave up my expensive Humana Medigap policy and joined Fallon’s Senior Medicare Advantage plan. It sounded okay on paper.
The customer service person who signed me up assured me Dana-Farber in Milford was covered by Fallon. Untrue. It left me without an oncologist. I was not too upset. I could see my Dana-Farber doctor once more and get a referral from him.
Wrong. My oncologist didn’t know anyone at UMass in Worcester which is Fallon’s only cancer care facility in the county.
Even this didn’t faze me. I’m in the maintenance phase. I go for checkups and blood tests. Nonetheless, cancer runs in my family. Mother. Brother. Both maternal grandparents. I’ve had cancer twice. It’s too soon to stop monitoring.
My Dana Farber oncologist said the UMass facility is good, but he couldn’t help me find a new doctor. He told me to call the HMO and ask them who they have in medical oncology with a specialty in breast cancer. I already knew my PCP couldn’t give me a referral.
I called Fallon.
She said — this is a quote: “We do not list our doctors by specialty.”
“What,” I asked, “Do you list them by? Alphabetically?”
I mean, seriously, if you don’t list doctors by specialty, how can anyone get an appropriate referral? This is senior health care . It’s cancer — not rare among the senior set. Not rare among any set.
I explained I needed a medical oncologist specializing in breast cancer. Cancer doctors are specialized and it did make a difference. No, there’s no such thing as “just an oncologist.” If ignorance was bliss, this was a happy woman.
I explained (again) it would not be okay to send me to “just any” oncologist. I needed a doctor who knew my cancer.
I spent an hour or two being told I needed to go to my primary care doctor for a referral. It was like talking to a robot. Another 45 minutes passed until I was transferred to a supervisor. I retold the story. She said she would “research the problem” and get back to me.
I called my doctor’s office, explained that I hadn’t been able to get a referral from the oncologist at the Dana-Farber, nor could I get a referral from Fallon who seemed to think my PCP should send me to the right doctor. Even though I told them that Dr. S. didn’t know the doctors at UMass, Worcester. I needed help.
A few hours later, my doctor’s office called back and gave me a name, an appointment, and a phone number. The appointment was for just a few days hence, also my birthday. I didn’t want an oncology appointment on my birthday. I called the office.
I got transferred, then transferred again. I ended up talking to Lisa, the administrator for the Breast Cancer Care department. It turned out the doctor with whom I’d been booked was a surgeon Also, they couldn’t do anything without my medical records — scattered through 3 hospitals and a doctor’s office.
Lisa said not to worry, she would take care of it. She did.
She changed the appointment, booked me with a doctor who specialized in my type of cancer, called the various offices and ordered my medical records sent to UMass. Said if I had any kind of problem, give her a call and she’d fix it. Women with cancer didn’t need extra problems. What a difference she made!
My PCP’s assistant called to ask why I’d cancelled the appointment she’d made. I explained that doctor was a surgeon. I’d already been surged. I needed a different doctor. She was pissed because it hadn’t been easy to get that appointment. She could not grasp the difference between a medical oncologist and a surgeon.
I explained again I didn’t need a surgeon. I have no breasts. I did need my medical records. She said yes, Lisa from UMass had called, but she wasn’t sure where to send them.
“Didn’t Lisa tell you where to send them?” I asked.
“Yes,” she said.
“Then … why don’t you send them where she told you to send them?”
“But you cancelled the appointment I made!” she said.
“I changed the appointment. Actually, Lisa changed it. Because the doctor to which you were sending me was the wrong doctor. Now I have an appointment with the right doctor. I’m not blaming you. Why are you mad at me?” I reassured her I truly appreciated her efforts.
“Oh,” she said. Not “I’m sorry.” Just “oh.”
“Right,” I said.
I subsequently got many calls from Fallon, all wanting to explain again why I was unhappy with their customer service. I said a patient should be able to call and get names of appropriate doctors and basic information about the doctor. This is fundamental to medical care.
Everyone agreed with me, but I was sure nothing would change. Inertia always wins.
The day was only half over; I was not done.
When I finished the marathon calls to Fallon, I got a call from Humana to remind me I hadn’t made a payment this month.
I hadn’t made the payment because I had cancelled the insurance when I switched to a Medicare Advantage (HMO) program. At the end of November, I had signed up with Fallon, then called Humana to cancel my policy as of the first of the year. I was told that as soon as my new program kicked in, the old policy would be automatically cancelled. There was nothing for me to do.
“Are you sure?” I asked.
“Absolutely,” I was told.
In was the middle of March. Humana was harassing me for money. When they called again, I got a person on the phone, pointed out I’d cancelled the plan.
The representative said that he could see in his records I’d called to cancel. I’d been given incorrect information. I had to send them a letter. I could not cancel by phone. I said I signed up by phone. Why did I have to write a letter to cancel?
“Those are the rules,” he said.
“I want to speak to your manager,” I said. He explained that the manager would tell me the same thing. I pointed out that I didn’t care, I wanted to talk to a manager. I didn’t owe them any money.
He said I’d have to file a dispute to not pay them. Although it was their fault and they could see I called to cancel the policy, I would have to fix the problem, though they caused it.
I thought my head would explode.
The manager reiterated indeed they’d given me incorrect information, but it was my problem. Tough luck lady. I hung up, steam coming out of my ears.
I took a breath, called their other customer service department.
The lady I spoke to looked it up, agreed they had given me erroneous information, contacted the cancellation department and assured me it was fixed. I have a name and a number in case it isn’t. I pointed out they had burned a whole year of good will in an hour. And any further harassment and I’d call the Attorney General and report them for sharp business practices.
It had grown dark while all this was going on and as the day had gone from morning to evening.
How come so many incompetent people have jobs? Why are they working when so many more intelligent and better qualified people are out of work? It’s a mystery.