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Getting screwed again by my HMO   3 comments

I’ve been in excruciating lower back pain, off and on since last September. I’ve had injections, chiropractic, Physical Therapy, Traction, and Acupuncture. Yesterday, I had to use the electric cart at my grocery story and was in unrelenting pain; fortunately one of the employees went around the store with me to get my groceries and help me checkout. On a scale of 1-10, this pain is a 12 and literally stops me in my tracks, and it has been nagging/gnawing at me for a good while, and only recently got even worse.

I have an HMO for health insurance and that means going through a primary care physician to get authorized/referred to a specialist. I have a pain management specialist who treated me for this last May-July. Since then I have been trying for relief through other modalities. I am not one to take narcotics for pain; I do have a tens unit and an ice pack. A week ago I made an appointment for tomorrow with the pain management specialist and have been awaiting the referral authorization since then. It should have been done within 48 hours. It is now a week later and guess what? I’ve just been called and informed that I have been authorized for a ‘visit’/consultation and must do that before I can get any treatment. That is what my appointment tomorrow is going to be even though I was very specific in requesting authorization for a treatment that I had had before from the same doctor.

The doctor has decided that she needs to see me first and then submit a request for treatment. The referral coordinator ignored my request and after a week submitted the request for an office visit. The result is that tomorrow, instead of getting the pain management treatment that I so desperately need, I’ll have 1 minute consultation that the doctor will bill more than $500 for to the insurance company (no wonder the costs are skyrocketing), and then tell me what the treatment will be and that an authorization request will be needed for another appointment.

Under the best of circumstances these referral authorizations take 48-72 hours to be approved. Factor in the time for the doctor to¬† compose her notes, send them to the transcriptionist so that her clinical notes can be sent to the primary care physician, fax that request to the primary physician. I’m looking at another 3-4 day minimum, before the authorization request will be made. That’s assuming that the referral coordinator does not forget to check the fax machines (and she has gone on vacation before, leaving one of these unattended), and submits the request. Then, if the request is made for STAT (ASA approval, expediting the authorization, it will be 48-72 hours for it to happen. Then I’ll have to make an appointment with the pain management doctor, who does huge business, and it could be at least a week, or even more, for another appointment.

Under the best of circumstances, I’ll be getting the treatment a week from tomorrow. Under the usual circumstance, I don’t really know how long it will be.

To make matters worse, I received a message just now from the referral coordinator telling me that she can no longer handle this matter because I have been transferred to another primary care physician (that does not go into effect until April 1, and I may have to wait until then, after a visit to that doctor on April 2, before the referral request can be made.

I may suffer excruciating pain between now and the second week in April, unless a miracle happens. This is worse than catch 22; it’s a good example of the flaws in the medical care system, particularly in the HMO, less expensive type, health insurance system.

I have a fairly high pain threshold; but this pain stops me in my tracks…I don’t know what I’m going to do until I get that pain injection.

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Getting fired again, as the host of a famous North Carolina restaurant   Leave a comment

To be continued…

Posted February 24, 2012 by djrnfla in Uncategorized

Held up at gunpoint at Domino’s Pizza   2 comments

Probably one of the scariest moments in my life. I was minding my own business at a Domino’s Pizza store when all of a sudden a young black man appeared with a gun. The store was being held up. This was about the time of that slaughter in a McDonald’s in California. This man was the lookout as his partner was in the office holding up the manager. I made the mistake of trying to hide my wallet and he noticed, came over to me, and put his gun in my chest and took the wallet. There were several others there at the same time, including one of the Domino’s employees (who later said that he wanted to knock the gun out of the man’s hand but was afraid that it would go off and I would be shot.)

Shortly after that, the other thief came running out, and the gunman left with him. The store manager was right on their heels and pursued them into the parking lot, where he managed to slap his hands on the trunk of their car as they fled. By sheer coincidence, a police car came by and the store manager told them what had just happened. A long, high speed pursuit followed; they were ultimately arrested. I was in shock; we all were stunned. The manager came back and tried to calm everyone down. I went home and had a sleepless night, feeling violated by the incident. I couldn’t believe what had happened! I was grateful to be alive. While the robbery attempt was in progress, we all were thinking about the McDonald’s tragedy and were wondering if we might be facing the same fate. Fortunately it did not work out that way!

I was interviewed twice by a detective who showed me photos and I was unable to identify the man who put the gun in my chest. They had been arrested however, even though they had ditched their guns out the window during the police pursuit. If it weren’t for the fingerprints of the store manager on the trunk of their car, they would not have been charged.

There was a trial and I was subpoena’d as a witness. Fortunately, at the trial of the older one who had gone into the manager’s office, we were informed that the gunman who had been the lookout (and put his gun in my chest), had already pleaded guilty, and that we would not be needed as witnesses. That was the end of it; justice was served.

It was a very traumatic experience for me. I was shaken. It was days before I was able to let go of the feelings of terror that I experienced with the gun in my chest. My worst nightmare.

In the end, I was grateful to be alive and know that the perps had been caught and were sent to prison. I survived.

You never know when this can happen. You see/read the news of violent encounters of all kinds; people highjacked, missing, killed, etc. and you think that it could never happen to you…well, it can.

 

Posted February 20, 2012 by djrnfla in Uncategorized

When I Got Fired as Maitre De at Rene’s Supper Club   1 comment

I was just doing my job…

As the maitre de/host at a night club that offered good music and dancing, my job was to make sure the customers were taken care of, handle reservations and special seating arrangements, and contribute to the friendly atmosphere of the place. It attracted a lot of single women because of the music and ‘safe environment’. The owner was also the featured singer and sounded like a replica of Neil Diamond. I got to know and be known by many of the regular customers who depended on me to ensure their ‘safety’ while they enjoyed the music. I believe that after a few months there, my reputation was contributing to the popularity of the club, attracting many new customers, mainly single women, as well as long time regular singles and couples. I was introduced to some of the ‘special’ regular customers who were friends of the owner/performer, and on several occasions was asked to stay after hours to dance with some of his very special friends.

One night a couple of clearly underage girls arrived and I did not allow them to come in, thinking that I was doing my job and showing loyalty to the owner in protecting him from any legal problems.

After work the very next day, the owner asked to see me at the end of the night. He fired me on the spot…(unbeknownst to me, those young girls were daughters of some his very special friends who were at the club the previous night.) I was not given any choice or opportunity to defend my actions. How was I supposed to know that these young girls were special guests?

I lost my job, my only source of income at the time, when all I was doing was my job, looking after the best interests of the owner and his club. I got screwed! Don’t you agree?

 

Posted February 20, 2012 by djrnfla in Uncategorized

My Second Victim Story: The Theft of My Inheritance!   Leave a comment

Wait until you hear this one…

To be continued.

Posted February 20, 2012 by djrnfla in Uncategorized

My First Victim Story: When I lost my position as Director of Radiation Oncology at the National Cancer Institute   Leave a comment

My most enjoyable and productive ‘job’ during my career at NIH National Institutes of Health (NIH), was when, as Special Assistant to the Director of the Treatment Division at the National Cancer Institute (NCI), I was given the additional responsibility as Acting Director of the Radiation Oncology Program while we recruited a radiation therapist for the position.

To be continued.

Posted February 19, 2012 by djrnfla in Uncategorized