Healthcare Rant: When Quality Care Goes Wrong

As I’ve been dealing with many difficult health issues this past year, the U.S. healthcare reform debate has fallen below the Nicole radar. It surprises me that I’ve avoided it, as my career is in healthcare administration. I know it’s an important time in my field, but seven months of unemployment have kept me out of the trenches. Despite a very concerted effort, I have not been able to find work in my field. Although I have skills that would be portable to many other fields, I don’t want to give up what I love. I believe that quality care should be available to all people, regardless of their ability to pay. While it’s true that many healthcare organizations offer charitable care to the needy, it seems like many people in need fall through the cracks.

I am currently insured through my husband’s employer on a plan with Cigna. The plan provides excellent benefits at a low cost for in-network providers. I am extremely lucky to have $5-10 copays, and very reasonable coinsurance. Unfortunately, the Cigna network has been fairly limited in both the Atlanta and Wasatch Front areas. In Atlanta, I couldn’t use Emory facilities in network (while working for Emory, and promoting their Campaign Emory fundraising). In Utah, 90% of Intermountain Healthcare facilities are out-of-network for Cigna. This is frustrating to me, as I’m a previous 4.5-year employee of Intermountain. I believe in their Mission, Vision, and Values, and want to support them with my healthcare dollar.

My previous positions with Intermountain were as an assistant to a medical director at LDS Hospital, and as a Patient Service Rep in Accounts Receivable Management. I have also worked for City of Hope Cancer Center, Prime Healthcare Services, and University of Michigan Medical Center. I have experience in customer service, billing, coding, transcription, Joint Commission an AOA accreditation, physician credentialing, training, research, and have processed countless financial assistance applications. I have participated in executive-level hospital management meetings. Although I am not an expert by any means, I can confidently say that I am qualified to have an educated opinion on what works in healthcare, and when healthcare goes wrong.

Case in point: My daughter Rosie has been sick for a few weeks with kidney problems. My otherwise lively child has been mopey and lethargic, and complains of pain daily. On Christmas night, Rosie was very sick and begged me to take her to the hospital. We left our family holiday party an drove to the IHC Provo Instacare (which is in-network with Cigna). I advised the Instacare registrar that I had submitted a financial assistance application to the Lake Park and Creek Plaza billing offices a few weeks prior, and was unable to pay a copay. The Instacare flat out refused to see her without a copay…so I ran out to the car, grabbed a Christmas card, and paid her copay with the Christmas cash I got from my grandma. And what happened then? They took her blood, scanned over the results, and told us to go across the parking lot to the Utah Valley Regional Center Emergency Room immediately (which we later found out was out-of-network).

The ER registrar was a little nicer, especially when I brought along the copy of my recently-completed financial assistance application. We sat in the ER waiting room for over an hour, and spent a few more hours in the ER room 9 (which had a broken recliner, and no other chair available). After 4 hours, they said her urinalysis showed that she had inflammatory cystitis. If the Instacare would have taken 5 extra minutes to take her urine, she could have gotten on antibiotics and saved us a 4-hour ER visit and copay.

When we arrived at Instacare, it was a few minutes before they were closing at 9 pm. They happily took us back to the room, but pushed us back out the door in 5 minutes.My question is: “If they were going to send her to the ER, why did they take my gift money to pay a copay for a “visit” that didn’t really end up being a VISIT?” Luckily these visits happened before the end of the year, because we’d already met our deductible. Had this happened a week later, we would have been slammed with deductible fees.

A few days later, Rosie had another ER visit. Her symptoms had worsened, she had a high fever, and I drove her back to the UVRMC ER (still not knowing it was out-of-network). The doctor wasn’t sure why she was in so much pain and guessed that she had kidney stones or appendicitis. He ordered an abdominal CT scan to see if the problem was GI or urinary. After 3 more hours of sitting on room 9’s broken recliner, we found out that her scan was fine. Rosie got a pain pill, some “orange pee” pills, and a stronger antibiotic. Since then, we’ve been following up with a non-IHC pediatric urologist and she’s doing much better.

I was going to just sweep this experience under the carpet, but then earlier this week I received several IHC financial assistance rejection letters. Besides the recent hospital visits, I had some outstanding bills from all of my sleep apnea visits. Apparently we are slightly over the National Income Poverty Guidelines (remember my husband is a struggling regional airline pilot?) Despite our unmanageable debt from student loans and my 7 months of unemployment, we do not qualify. When I called the billing offices to get more information, I was told that our income was slightly too high, and our balances were not high enough for them to make an exception. Gee thanks.

I know I’m not the only person to have an experience like this. After going through it personally, it has really lit my fire to get back into a position where I can help avoid situations like this. I’m going to keep working on my medical coding certification, which I’ve been working on from home to keep myself busy while looking for work. It’s time to make my voice heard. I’ve been in both hospital management, and also at the receiving end of a “charity” denial. I hereby recommit my effort to apply for all the positions I am qualified for. I need to be a part of my field again.

Letters I hate to receive

Letters that I’ve received this week, that I wish that I hadn’t opened:

“A case of headlice has been reported in your son and/or daughter’s classroom”

“A registered sex offender has moved into your building”

“The forbearance period has ended on loan XXXXXXX, and payments resume starting March 31”

…and of course, all the bank statements and student loan statements. I used to love checking the mail back when I had a zillion pen pals and actually got real letters. Now I’m lucky if I get a baby shower invitation sent every few months.

Oh, by the way, the price of a first class stamp goes up to $.44 on May 11. Lame.

Postscript – Two thorough checks, and Rosie’s lice free. Whew!

Today’s Rants

Olive Garden Restaurant
4749 Ashford Dunwoody Rd NE
Atlanta, GA 30338

Dear Manager,
I still have a bad taste in my mouth after eating at your restaurant last night. My food was okay…mediocre I suppose…but that is what I’ve come to expect from Olive Garden. It was a lame idea for your big-wigs to make the soup and salad “special” $9, because that’s about all I really enjoy at your establishment and more than a lot of your menu items that INCLUDE soup, salad, and breadsticks. Kinda like when you charge $3 for a little 1.5 ounce ramekin of marinara to dip your breadsticks, but you never say it’s an additional cost. But what I’m frustrated about today is how I was treated when I contested my bill last night. My daughter was in the mood for shrimp and I asked the server if any of the kids meals could have shrimp. He said “For you little girl, of course!” and he put in the order for the pasty little bowl of fettuccine alfredo. The shrimp was good, but I was appalled that the $4 pasta kids meal turned into a $9 kids meal with the addition of the shrimp. Really? $4.95 for 3 pieces of shrimp? Ridiculous. Even worse, the server insinuated that he was giving us a freebie, and then did the bait-n-switch to make her gross pasta bowl more expensive than my mediocre mezzaluna pasta. I talked to my server, and he said he’d have the manager take care of it. The manager came over, and said “as a courtesy” he knocked the price down to $2.95 for the shrimp…but he warned us that NEXT TIME we’d be charged full price. Next time? NEXT TIME? No, there will be no next time. I’m done with Olive Garden.



Dear City of La Verne, CA,

I am again contesting the parking ticket issued to my rental car on November 1, 2008 at 6:01 am. The infraction was for parking in a driveway and blocking the sidewalk. As you know, the city ordinance is that no parking is allowed on the street at night to allow a semi-monthly streetsweeper right-of-way. After my Halloween festivities, I parked my car behind my in-laws van, and went to sleep. They had used a large fire portable firepit in the driveway for keeping the trick-or-treaters warm as they hollered for their candy. Because of this burning hot firepit, it could not be moved to the backyard, and the van was parked as close to the pit as safe. I in turn parked the car right behind the van, but the bumper of the car was hanging over the last slab of driveway about 4 inches. The sidewalk right-of-way was slightly hindered, but completely accessible by bike, pedestrian, or wheelchair. Yes, I know my in-laws neighbors hate them, and call the police department and child protective services 2-5 times per month to spite them (and also turn the sprinklers on all the kids for trying to trick-or-treat at their door) But it was obviously them who tipped you off that one minute after the street was available to park on, a ticket was placed on my $14/day Jetta.

I paid the $25 ticket online, expeditiously to avoid a late fee, but also turned in an appeal. The appeal was never answered, which didn’t surprise me. But today in the mail I received a late notice for $115. I ALREADY PAID THE TICKET AND HAVE THE EMAIL CONFIRMATION! But you have no record. I have to fax a copy of the ticket, my bank statement, and the email receipt. Unfortunately, the ticket and bank statement is in a box in transit between Michigan and Georgia. And if I don’t pay the ticket again by Monday, it’s another $25 late fee tacked on.

For a city I love so much, I’m not so happy about you La Verne.



Dear Taylor,
I love you so much, and I’m so appreciative that you have worked so hard this week to pack up the rest of our life in Michigan. We will likely never experience the crazy cold temperatures that we did in Detroit. However, please stop teasing me for being cold. It’s 38 degrees out here in Atlanta, and I’m in the house shivering in my parka because it’s so cold. Rosie’s wrapped up in a blanket next to me. You tease me for wanting to turn on the heater. But you have your coat on and are complaining about it being too hot. Can’t you just take of your coat and long sleeve shirt, and let us turn on the heat so we stop shivering?




As many of my blog readers know, I’ve had some pretty terrible experiences with my teeth. From my early years, I dreaded visiting the otherwise lovely Dr. Edvalson from church because I knew the visit would end up in bad news, pain, and unhappy parents who couldn’t afford the fillings. I’ve had some pretty hellacious dental visits in my 28 years, but today took the cake.

I went to my new office in Canton today, as recommended by my coworker. I explained the last 8 months of my dental history, including which teeth had been worked on, pain, sensitivity, and rough edges. He looked in my mouth for less than a minute, and looked me in the eye and said “I’ve got some bad news.”

He came to explain that all of the teeth that I’d opted to have CEREC work done on were done incompetently. The two teeth have have been pushing me toward the Vicodin bottle for the last month were full of decay, and would need a root canal ASAP. The CEREC material was breaking off in chunks, and as I held up the mirror as he scraped…I knew he was right.

For those not familliar with CEREC, it is a dental restoration product that uses 3D technology and CAD/CAM to make a tooth replacement that does not require a dental lab. When I was deciding between CEREC and other crown substances, I was talked into the CEREC because I was told that it will last several years longer than ceramic fused to metal. It can supposedly be done in one office visit, but for some reason I always had to come back for a second visit. CEREC should be used with discretion, as not all patients are good candidates, especially on molars. It also causes a lot of tooth sensitivity, which I’ve been experiencing for months.

When I had the work done last fall, I had a lousy HMO plan, but the feel schedule said I should have been paying approximately $400 for the crown and buildup per tooth. But for some reason, they kept saying that I was required to pay an extra coinsurance on top of that. All the work ended up being around $2000. I talked to my dental HMO several times, and they told me that it was basically up to the discretion of the office to determine the coinsurance amount. That should have been my first red flag.

Another gripe I had with the office was that I knew I had several teeth that needed work, but very little time till I was moving out of state. In once terrible visit, I was subjected to nearly 5 hours in the chair, being shot, drilled, and bonded in all four quadrants of my mouth. I had asked to have only the most VITAL teeth worked on, and they took the liberty of starting every tooth in one visit. I left the office with a 2 year repayment plan and a majorly bad taste in my mouth.

So here we are…needed a mouthful of work done again, still paying off my shoddy work, and having the worry that my new insurance companies (I’m double covered now) may deny the work because it is less than 5 years old (*#%^*&!!!)

My new dentist suggests that I get the Michigan Board of Dentistry, California Board of Dentistry, and an attorney involved. He said that a reputable dentist would take accountability and refund the work and help cover the cost of restoration, but I have a funny feeling they’ll hire their own attorney and find a way to blame it on me. It’s going to be an expensive, painful, time-consuming and messy hassle!

Feelin’ Ranty

I’ve just been in a bummer mood today. My weekend started out good, going out with Mike and Erin last night. I woke up this morning and went to the RS humanitarian project where I sewed baby sleeper gowns. But when I got home…it was homework time. I know I’ve got less than two weeks to go this semester, and it’s stressing me out bigtime. I’m neck-deep into my critical writing class, and I’m way too critical of my own writing. So after I finished the assignment I was on, I decided to go to the gym. I went on the eliptical for 30 minutes, and after six weeks of “no exercise” doctors orders…it made me feel yucky. I left with crampy muscles, sweaty body, and a little dizzy. Then I came home to answer a cascade of HS reunion emails. I’d voluntarily agreed to help out with the reunion this year, but it’s becoming a burden to coordinate. I have a few people willing to help, but I’m having a hard time delegating because it requires a lot of thinking to give direction. I’ve been linking up other MHS graduates on the reunion blog, and as I’ve read through those blogs…I’ve indirectly found negative feedback on the plans that have been decided. I figure in the last 3 months, I’ve put in 25 solid hours of emailing, researching, updating the blog, etc. I’m feeling a little taken advantage of…but it’s self-inflicted because I agreed to help. *sigh*

Taylor decided to take on a tougher schedule this month, because the high-speed schedule only allows you minimum monthly pay. Finances have been dreadfully tight, so it’s a good financial decision. But I’ve been savoring those hour-and-a-half evening together times (between when I get home from work and he leaves for the airport). It’ll take some getting used to.

But in happier news, Michigan is abloom in tulips, daffodils, crocuses, and other spring flowers. The leaves on the trees are sprouting and the “popcorn trees” are full of white and pink blossoms.

My spontaneously combusting mind

Over the last few days, I’ve had a zillion things spinning through my head. I’ve been super stressed and thinking about all the things I could blog about…but tonight is just going to be a ranty, complaining emotion blurt. Usually I blog about the good things in life, but tonight I really need to vent. Reader beware.

So far work is going okay. My surgeon has been fine to work with, my coworkers are helpful and I’m learning a lot about thoracic surgery. My complaints are the yucky parking situation, e-learning courses and the expensive employee cafeteria. The drive to Ann Arbor takes 25-40 minutes, depending on the day. Whether I take M-14, Plymouth Road, or Ford Road…it’s all about the same. The only parking lot I have been able to consistently find a spot at 7:30ish is the Glazier lot. It’s a 15 minute shuttle ride to the hospital, and the shuttles run pretty frequently. The downside is you have to make sure you always bring everything you could possibly need when you leave in the morning. If you forget your lunch or employee badge…it could take you an hour to shuttle to your car and back. Also, I have to complete this super boring set of 11 modules in order to get access to do financial transactions on behalf of the department. I’ve done non-P.O. vouchers and purchase requisitions before…so the training just feels tedious, and it’s hard to concentrate when I have people at my desk all the time. And the cafeteria…well, the food’s okay, but I sure don’t want to pay $6 for a food service sandwich. Meals are in the $5-$8 price range, but it’s nothing spectacular. I’ve been eating a lot of Lean Cuisines.

Taylor had another incident with his car in the employee parking lot. First his car was sideswiped, now this week the back bumper was brutally scraped and dented. It’s frustrating that this is happening in a lot that is “SECURE” and requires SIDA identification to enter. Oh, how I miss the honesty of people on the west coast who leave a note… Neither damage is bad enough that we NEED to repair it, but it’s upsetting that his 6 week old car had no body damage when we bought it…and now has two major exterior flaws.

School is driving me nuts. Actually, it’s driving me to tears. Going to school online can be useful, because you can study on your own timetable. Unfortunately, you are sometimes bombarded with additional study aids, and not given clear instructions of how to complete your courses. I’ve been enrolled in a 9-credit algebra and statistics survey since January. I haven’t really put major time into it until this month (due to family situation in Utah, moving cross country, being sick, traveling, etc…) and until this last week I found out that I was following the wrong course of study. I tried to submit my first (of 13) assignments, and spent 2 hours on the first two questions! I’m so out of practice in math, and all of the review work that I’ve been focusing on the last 20 study hours has not prepared me for my homework. I’m almost done with the critical thinking and writing survey though…I should be totally done with that in a week or two. I am contemplating a leave of absence from school after my finals in May. As much as I want to get my degree, my family and sanity is more important at this point.

Our finances are a total wreck, thanks to the airline’s 3 day direct deposit delay. Bank of America got Taylor’s paycheck funded on a Tuesday, and he was supposed to get it the previous Friday. We didn’t realize the error until Taylor’s debit card was declined. Over the course of 3 days, we got hit with $455 of overdraft charges (mostly on transactions less than $10). There are no BofA branches in Michigan, so we had to get a family member to bail us out $250 to bring our account out of the hole. Unfortunately, that deposit didn’t post till the next day, so we got hit with another $150 of charges, and the account was still below zero. It took several customer dis-service phone calls to BofA to figure out the error. We finally got $220 of the charges written off, but we were still left with only $150 in the account, and no student loan payments have been made yet this month. My first paycheck came, but it was only for a few days work. It was enough to pay my credit card, buy gas, and get groceries. We’re going to have creditors hounding us for the first time ever. It’s a terrible feeling.

We’re also feeling the uncertainty of the airline industry. Just knowing what’s been in the news with ATA, Skybus, Aloha, and Champion airlines has been worrisome. Now the word is that Delta and Northwest will announce their merger in the next day or two. It could be shaky ground for us. Hopefully, Taylor’s airline won’t have any problems keeping their contract, but the pilot contract is really shaky. There will be some picketing at the Memphis headquarters on May Day. Hopefully our pilots will get the raise they so desperately need and deserve. No professional pilot should be making an income that qualifies a family of three for food stamps.

I’m feeling lonely in Michigan. I have very few friends. I have quite a few acquaintances, but still nobody that I can just stop and their house and crash on their couch with no notice. I did finally meet up with Umeka and Brandon last night. It was the first time we actually got together. I found her on Myspace around the time we decided to move to Detroit. We went to Detroit Greektown, ate dinner at Pizza Papalis, walked around Ford Field and Comerica Park, and other downtown treasures. It was a rainy night, but it was a safe and interesting part of town. I wish they lived closer so we could see them more often.

I’m still feeling sick. Most of my physical symptoms are better, but my ear still hurts like crazy, and my teeth are almost always throbbing like crazy. I need to find a dentist and primary care doctor in Ann Arbor. Now that I’m double covered, out of pocket expenses should be minimal; however, my insurance plan is an HMO that requires a referral to see a specialist. I’ve got an Otolaryngology clinic one floor down from my office. Maybe I can sweet talk my current PCP into a referral without the drive to Westland. As for my teeth…who knows? I’m already paying $180 a month to pay off all the dental work I had done in December. Could I really have more that needs to be done after 3 months? I sure hope not. And we just won’t talk about the weight I’ve gained since being sick….

I’ve got an extra ticket to see Ben Folds on Wednesday night, and Taylor’s stuck on a high-speed that night. Anyone want to come? Only $15!