Showing posts with label MedFin. Show all posts
Showing posts with label MedFin. Show all posts

Beware Riverside County Medi-Cal Social Services in Hemet, California - A Review

The old and current card for existing California Medi-Cal recipients.
Card remains valid.

About:
Department Of Public Social Services (Self-Sufficiency)
541 N San Jacinto St, Hemet, CA 92543
Department of Social Services

Never, ever, give Riverside County Medi-Cal Social Services in Hemet, California any piece of paper without getting a receipt for it. Never, ever, upload or mail anything to Riverside County Medi-Cal Social Services in Hemet, California. They will claim they never received it. Failure to follow this advice will give you immeasurable grief (based on personal experience).

It gets worse. They will also outright lie to you. They will tell you over the phone that everything is fine, then 2-3 months later you will start getting notices in the mail saying that you owe money. This will be because either:
  • They reneged on everything and never bothered to tell you.
Or
  • They messed up, discovered their error, messed up again when semi-fixing it, and then tried to cover it up instead of warning you about it. By the time you discover it, it's too late to request a State Hearing to get the rest of it cleaned up.

On other occasions, they've sent me ultimatums with due dates earlier than when they sent out the letter. Then you discover your Medi-Cal insurance and/or QMB have been cancelled; again without any notification or warning whatsoever.

Be advised that once you have the Medi-Cal mess straightened out; Medi-Call apparently doesn't tell the subsidiary plans that things have been fixed, IEHP being an example. You have to call IEHP or whoever and get it straightened out on your own. Also, if you had Denti-Cal; you may have lost that as well.

These are not isolated occurrences. These incidents have been going on for years.

[Update] The above and various versions of this have now happened to me multiple times. Based on my previous experiences, the following will now also happen again:
  1. Even though fixed, the Hemet Medi-Cal office will still pass along the original false information on to the State of California.
  2. State of California then automatically passes along the false information to Social Security. This includes the withholding of the QMB payment from Social Security.
  3. Chaos will then automatically ensue as to my monthly Social Security retirement benefits amount re QMB and such. Last time this happened, it took 1-2 months before it hit; slow pipeline apparently.
  4. Then it eventually gets mostly fixed within another 2-3 months, again the slow pipeline issue. The last time, some money was permanently lost, as in gone forever. This was because of the previously mentioned no-warning issue. This time, I know it's coming; so I may be able to recover all of it.
It's probably going to be a lost cause, but I will call social Security and warn them what is coming down the pike. It's a long shot, but maybe they have the capability to be prepared and abort the sequence before or when it happens. We shall see. Am not hopeful. I'll post updates as they happen. I've also fired off an email to the relevant California State site. Here's a list of Federal/State sites that might actually help you.

[Update: Research seems to indicate the above description is a state-wide problem. Research also indicates that the frontline California Medi-Cal social services workers are treated even worse than the California Medi-Cal patients. So when the inevitable happens to you, let the worker know you know and understand.]

The new and current card for new and existing California Medi-Cal recipients.
Both cards are valid.

A side note. You will need one of the above cards when you go to Hemet Social Services Medi-Cal office to submit your paperwork at the imaging kiosk. When you use the kiosk, it will automatically give you a receipt.

Or so
Department Of Public Social Services (Self-Sufficiency)
541 N San Jacinto St, Hemet, CA 92543
Department of Social Services
says.

[update] Have now been told via other comments  case number is enough.

Help with Medical Bills Federal and State Websites

These websites will actually help you when a medical entity victimizes you with inflated or outright fraudulent medical bills and/or denied insurance claims.

This includes hospitals, general doctors, specialists, X-ray places, CT scan or PET scan centers, blood test places, and pretty much any other medical facility or entity that engages in illegal or unethical conduct. Emphasis is on illegal, unethical contracts and on illegal, unethical billing practices. Also includes resources regarding insurance company misconduct or for when a Medicare, Medicaid, or Medi-Cal case worker makes a mistake or acts in bad faith. Sooner or later, you will need the information on this page.

Medical Federal and California (and other) State Government Websites That Will Help You When an Insurance Company or Service Provider Victimizes You – Also Some Worthwhile Additional Information


Patients Rights Help and Support Resource List

A list of resources regarding the rights patients are legally supposed to have. Many provide complaint forms and will actually help you. All listed websites are government or other well-known, reputable resources. All links go directly to the website's patients rights page and/or patients help page.
  • MedlinePlus, from the U.S. Library of National Medicine.
  • HealthCare.gov, your rights under the Affordable Care Act.
  • Medicare.gov, your Medicare rights.
  • The Medicare Beneficiary Ombudsman. , a resource for filing complaints, grievances, appeals, etc.; in other words, a place to rat out medical service providers. The page also promises to provide information, help, assistance, and other services. The page is apparently also the starting point for when you need to deal with Medicare's own shenanigans.
  • CMS.gov, Centers for Medicare & Medicaid Services. The particular link I provided has to do with Consumer Information & Insurance Oversight. The page may not especially look it, but these guys are your friend. Sometimes, out of the blue and without any action on your part, they will send you notices a particular medical bill from a medical service provider or insurance entity is not valid and that you don't have to pay it. This website is definitely worth prowling around when you have the time.
  • California Department of Public Health (CDPH), the go-to page for filing medical complaints in California.
  • Office of the Patient Advocate (OPA), another go-to page for filing medical complaints in California.
  • CDSS is another California site that my be able to help you, especially as applies to local office Medi-Cal screw-ups.
  • Google. For folks not in California, simply do a search for:
    "YourStateNameHere patients rights site:.gov" (without the quotes and be sure to include the exact "site:.gov" syntax).
If a link suddenly stops working, it means the website moved that particular page. Let me know in the comments section and I'll find and post the new location.

Some Tips for When Dealing with the Medical Bureaucracy

  • The Medicare 1-800-633-4227 number is open 24/7. They have always been friendly, professional, and helpful.
  • Referring doctors make paperwork mistakes all the time. Whenever possible make sure the medical treatment specifications match what the Medicare white book says. This is mostly applicable to preventive services. Not kidding here, make sure the doctor's instructions exactly match what the white book specifies. I've personally saved myself one financial disaster already by doing this.
  • Never walk into a medical service provider's diagnostic center without the proper Medicare COPD 5-digit code included on the referral paperwork. 
  • Referring doctors make paperwork mistakes all the time (did I mention that already?). Always call the Medicare number first and verify the accuracy of the Medicare code on the paperwork before going to the specialist's or medical service provider's office. Confirm with Medicare that the Medicare code number is valid for your circumstances and procedure(s) and that Medicare will approve and pay for the procedure.
  • When referred to a specialist, sometimes a COPD code isn't provided; the specialist adds the code after the fact. Your only defense against this is having diagnostic information showing the necessity of the visit to the specialist, e.g., CAT scan shows potential malignancies in lungs, thus being referred to a pulmonologist makes medical sense. If the specialists uses the wrong code(s) after the fact and the claim is denied, don't just give up. Work with Medicare and the specialist to get the mistake straightened out and resubmit the claim.
  • The referring doctor does not not always know if the referred specialist or medical service provider takes Medicare, Medicaid, Medi-Cal, etc. When you walk into that referred specialist's office or medical service center for the first time and have identified yourself, always ask first:
  1. Does Medicare accept you and do you accept Medicare as full payment, secondary insurance covering remaining balance?
  2. Does Medicaid//Medi-Cal/Etc. accept you and do you accept Medicaid, Medi-Cal, etc. or whatever other supporting insurance applicable in your situation as full payment?
If any part of their answer is no, leave immediately. As a Medicare beneficiary, you have the right to go to any Medicare specialist or service provider center you wish. Tell your primary, referring doctor what happened and they'll take care of it.

An important note. If a medical entity financially victimizes you or is trying to victimize you happens to be a referral from your doctor, first check with Medicare via their website and/or phone calls and find out exactly what is going on. If that doesn't clarify or fix the situation, then tell your doctor's office all about it. They might be able to fix the problem with just one phone call to the offending medical entity; not so surprisingly, your doctor's office will often be quite successful at this.

A personal note. That medical contract you are always forced to sign is basically a blank check allowing the medical entity to do whatever they want. You've given them the right to do anything and everything their hearts desire and then to bill you for whatever insurance doesn't cover. For that reason, I always print directly above my signature the following in caps:

"ONLY PROVIDE INSURANCE COVERED SERVICES ONLY"

If the medical service provider then refuses you as a patient, immediately inform your primary physician that referred you. If that doesn't solve the problem, i.e., your doctor being able to find a different service provider in the area; I'd personally let Medicare, Medicaid/Medi-Cal, and any other involved insurance/government entity know all about it. I would think they would all want to know about a medical service provider that turns away patients simply because that patient only wants those services that are covered by insurance. Who knows? They might even be able to help you.

An update (Medical Hack(?)). Someone sent me this. I do not know if it is true or not. It sure would be interesting to find out:


I'm continuing to look for other government medical websites that help patients when it comes to money issues. If you happen to know of one, please mention it in comments. I'll be happy to include it on the list. Federal sites are preferred, but sites specific to your state are also welcome.

Body Donation Process and Free Cremation

Here is what happens when you donate a body to medicine, science, industry, research.
Rule Number One for Caregiver: Have Choices Made and Everything Done Before Occurrence.
This page is not for everyone. It serves up the truth, the whole truth, and nothing but the truth. And it is not gentle about it. Here is what happens and how to donate a body to get a free cremation.


How to Get a Free Cremation by Making a Whole Body Donation

There is a fairly new industry now in existence. It is the business of whole body donations. This is an information article for anyone who is considering making a whole body donation of either themselves or of a loved one. It is the industry standard a whole body donation entitles the donor to free cremation, free transportation, and generally free everything else relating to the cremation.

Overview of the Body Donation Industry

It is illegal for you to sell your body or that of a loved one. However, if you make a whole body donation; the company will pay all transportation costs, the cremation fee, the cost of the urn, and all other incidental costs. This is the industry standard, but each company may be different; so it is imperative to read the contract to be sure.

The company will work with one or more local funeral homes. The funeral home will pick up and transport the body. The company will make all the arrangements. Once the body is at the funeral home, the company will make a final determination as to whether to accept it. If they decide to accept it, the body will then be transported to the company's facilities; often this will be in another state. After one to two months, the remains will be cremated and per your instructions, returned to you or scattered at sea.

If the company rejects the body at time of death, the body stays at whatever funeral home the company happened to have selected. You are then liable for whatever the funeral home wishes to charge you for the transportation costs, cremation costs, etc. This seldom happens; each whole-body-donation company has their own rules; so be sure to read the contract.

Not Just Organ Donation: The Good, the Bad, and the Ugly.

The company will inform you the donation of your body or that of a loved one will contribute to the causes of science, education and research. In actuality this means the body or its various parts can and will be used for practically anything. You are not allowed to restrict how the body of you or your loved one may be used.

Once your body or the body of your loved one is at the company's main facility, the sales frenzy begins. Although it is illegal to sell a body or any of its parts, the whole-body-donation companies have found a way around this. As an example, suppose the company gets an order from a customer for a liver; the company will donate the liver, but will charge fees for everything related to it; such as extraction, preparation, and transportation.

First and foremost is the use of dead body parts to cure and heal the living. This is not the usual harvesting of organs immediately after death. Cadaver materials such as skin and bones can be processed into products and materials which are sold to hospitals to treat patients.

The next best scenario is when the cadaver's organs and tissues are harvested and sent to various institutions for medical research. This is the image most of us picture and is indeed many times the case.

However, the company has many different customers and many different types of sales orders.
  • Medical teaching facilities, especially colleges and universities, are steady customers of whole-body-donation companies. Your body or that of your loved one may very well end up at one of these institutions. This is not necessarily a bad thing. Contributing to the education of future doctors and researchers is always a worthy cause. It is possible, however, you or your loved one may end up as the guest of honor at a frat party. Another less pleasant scenario is when the body is chosen as a semester-long project. This is where the body lays on a table for a few months and is gradually cut and picked apart piece by piece; usually rock music will be playing in the background as the students crack jokes.
  • The United States Military is an avid customer of whole-body-donation companies. The military likes to use the bodies for researching and testing their new protective gear. You or your loved one may also be used to test the destructive attributes of new ammunition or explosives. No doubt other government agencies are also customers. One can only speculate as to which agencies and what the bodies or their various parts are used for.
  • Many non-medical biotechnology and other companies are also regular customers of the whole-body-donation industry.
  • Believe it or not, most of the above scenarios do not cause people to reject the idea of whole body donation. However this last scenario does seem to be a deal-breaker for many people. It has to do with the following sentence you will find in the Donor Consent Form Contract: “I am consenting the body to potential segmentation and disarticulation”. In other words, the company rips the body apart; piece by piece and day after day. Here is a typical scenario: Minnesota orders an arm; it is removed and sent. Next day Nevada orders a leg; it is done. Sooner or later the inevitable order for a head floats in; off it goes. Soon all that remains is the torso (probably minus the organs). This is not the image of a loved one many people want to carry around for the rest of their lives.

Whole Body Donations and Free Cremations

The Hopeful Future

The Future Is Now...?

The purchasing company can do anything they want with the body, but as the industry matures it is hoped someday you will have the right to specify the fate of yourself or your loved one. Hopefully, the time could be soon. In fact, since the industry has been around for awhile; it could literally happen any day now. Be sure to ask what options are available and if there are any restrictions you can impose. Do not take anyone's word for anything. Ask for the contract. Inform the salesperson you will read it and get back to them. If they try to make excuses or otherwise object, then probably do not consider that company as one of your possible choices.

Rule Number One for Caregiver: Have Choices Made and Everything Done Before Occurrence.*

*This is the voice of experience talking. Then when the time comes and depending on circumstances, you will then only be faced with having to make that phone call; everything else will then be automatically taken care of.

And as a hospice worker told me the following day: when your body wants to cry, let it. And she was not just talking about that day, but future days and weeks as well. When your body wants to cry, let it. Don't fight it, just let it. And do not care if other people happen to be around at the time. The less you fight it, the sooner you will heal.

Medical Service Provider Corruption - Patients Forced to Sign SWAG Medical Contracts Under Duress

[This page was originally entitled "Medical Imaging and Diagnostic Centers Saying Medicare Part B Reneges on Paying for Preventative Services" and was about a local incident. The page has since been expanded to address other local incidents and as they relate to the national issue. Bottom of the page has a list of government bookmarks for helping patients deal with unethical medical conduct. Page may occasionally be updated as more information comes to light.

The problem is the medical service provider is trying to
make the patient responsible for Medicare's conduct.

October 13, 2016 (first local incident)

Per doctor's written instructions, I went to an imaging/diagnostic center (name temporarily redacted) for chest/lung X-rays. I had been to this place before a couple years ago and there hadn't been any problems.

As with most medical service providers, I was first directed to the Hallowed Contract Signing Room. And there is where everything fell apart...

They placed a contract in front of me that basically said (paraphrasing):
  • We will take the X-rays.
  • We will bill Medicare.
  • Medicare will then decide if the X-rays were medically necessary or not.
  • If Medicare unilaterally decides the X-rays were not necessary and refuses to pay, then you must pay instead.
  • If you refuse to sign this contract, we will refuse to do the X-rays your doctor ordered.
In other words, the imaging/diagnostic center is claiming:
  • That Medicare no longer considers a doctor's word or judgement good enough.
  • That Medicare sometimes reneges on payments and that I am supposed to protect the imaging/diagnostic center from this by agreeing to pay them myself in such cases.

I felt sympathy for the woman at the desk, I knew she was just following orders.

So, is this a Medicare issue or is this an imaging/diagnostic centers issue? Or maybe it is only this one service provider that is pulling this stunt and Medicare is being falsely accused? [Incident is sorted out in next section.]

As a side note, I asked for a copy of the contract to show the doctor as to why I didn't get the X-rays and the imaging/diagnostic center flatly refused.

October 27, 2016 (second local incident)

Per doctor's written instructions, I went to a local blood lab (name temporarily redacted) this morning. While in the back room, they came in with a contract saying certain medical codes were missing and I would have to agree to pay for what Medicare wouldn't pay because of the missing codes. I declined, at which point they said they would contact the referring doctor's office and get the codes.

They then came back and said they had got the codes and proceeded to take my blood. I never had to sign anything and all appeared well.

When I got home, it occurred to me to call the doc's office to see if the blood lab really did call them and get the codes.The Doc's Office Said They Never Received Any Such Call. They further said they would look into and deal with it, and that I would not be responsible for any bills.

I'll wait to see how this sorts out before acting further. I never signed or agreed to anything. So if I do receive any sort of bill, I will perceive it as attempted fraud on the part of the blood lab and will indeed name names, unlike my still withholding the name of the imaging/diagnostic center.

When I first reported about this second incident, I received input from others stating such things as...
  • They have been nothing but trouble for people with Medicare or PPO health insurance.
  •  Credit card numbers demanded in advance before agreeing to do blood work.
  • Collection agencies being used on unwarranted/disputed bills.
This incident is considerably worse than the first incident, in fact it makes the first incident pale by comparison. I'm waiting to see how my situation turns out before acting accordingly.

November 15, 2016 update: still no bill received.

Early November, 2016 (third local incident)

Per doc's referral, I went to an eye doctor place (name temporarily redacted) and made an appointment. After making the appointment, I then perused their frames selection. The prices were literally double to triple the prices that can be found elsewhere, presumably the lens prices would be equally exorbitant.

The place was packed with patients/customers, noticing that caused me conflicted emotions...
  • On the one hand, I am pro capitalism. If a business entity discovers an unending supply of customers who voluntarily pay double to triple the going rate for a product or service, then you really can't fault the business entity for taking advantage of that.
  • On the other hand, pretty much all the patients/customers there were extremely old people who just plain no longer apparently had the mental faculties to know any better or the ability to  realize what was going on. I'm not an attorney, but this could easily be perceived as a case for elder abuse. Most insurance does not pay for frames and lenses, only for the exams.
At any rate, I mulled things over and cancelled my appointment. I may or may not work up the energy to look into this particular situation further.

The National Problem

[This page started out being about the actions of a single medical service provider. However it has now become about the national issue of medical service providers denying patients medical care unless the patient agrees  to sign what are known as SWAG CONTRACTS.]

Continuation and Update

I called the doctor's office. Yep, apparently most imaging/diagnostics centers are now pulling this stunt.

A patient being held responsible for a bill, because they falsely claimed they were insured, is indeed as it should be. However, a service provider attempting to force a patient to be held responsible for an insurer's breach of contract, bureaucracy, bad faith conduct, mistakes, or even just a misunderstanding is not.

The contract is between the service provider and the insurer, it is their responsibilities to understand and agree to the terms. Any attempt by a medical service provider to make a patient responsible for an insurer's actions is, to me, an essentially bad faith action on the part of the provider. Basically, the medical service provider is extorting the patient to insure the provider against the actions of the insurer, the threat being the withholding of needed medical care if the patient refuses to do so. In other words, patients are being forced to sign under duress.

Proposed Solution


Is it any wonder most countries think America has the most corrupt Medical Establishment on the planet? Our government keeps trying to fight it. But the greed and corruption is so entrenched, ingrained, embedded, and widespread (there are media reports almost daily on the subject) that nationalization of the medical industry may indeed be the only answer.

There would still be private sector medical professionals, but the government would be the single insurer and the only legally responsible payer. And it would be illegal for any private sector medical entity to try to coerce a patient into signing any sort of contract. Proof and authentication of identity would be all that is required, preauthorization for medical procedures implemented on an as needed basis. Premiums would be based on income.  Service providers (including hospitals) would no longer have to worry about being paid. Patients would no longer have to worry about being thrown into financial hardship or outright bankruptcy.

Meanwhile and for the time being, if a service provider hands you a contract such as the one I described in the above bulleted list.... Inform them that if they are unwilling to trust the insurer, then neither are you. You will no doubt immediately be thrown out, but at least you wont be a patsy.

You might try suggesting the service provider get preauthorization from the insurer. However and for some unknown reason, there are apparently some medical service providers who refuse to make the 3-minute phone call, the initially mentioned imaging and diagnostic center being one such case.

On a personal note, I am aware versions of this situation have been going on for decades. I have always circumvented the problem by simply adding the following sentence directly above my signature in caps:"ONLY PROVIDE INSURANCE COVERED SERVICES ONLY". The service provider then gets everything pre-authorized and there has never been a problem. As to why this particular, aforementioned imaging and diagnostic center is pulling this new stunt is beyond me. I live in a small town, hopefully the situation isn't as bad as the doctor's office has indicated and they can find a more ethical place to refer me.

This Has to Stop

A Bookmarks Reference List of Patients Bill of Rights Resources

I figured while I was at it, I might as well compile a list of resources regarding the rights patients are legally supposed to have. All listed websites are government or other well-known, reputable sources. All links go directly to the website's patients rights and assistance pages. I might add to this list from time to time.

Update:

List moved to Government Help for When Subjected to Medical Misconduct Victimization. Particularly relates to financial and billing misconduct.

List of Legitimate Medical Websites

Updated for Year 2018


And do note the final resource listed under the $100 bills.
You will be glad you did.


Resource Description
Fighting Patient Financial Abuse Patients Forced to Sign SWAG Medical Contracts Under Duress. Includes additional resources to fight back.
...nih.gov/... Patient rights, and much more.
consumer.gov/... Patient rights, and much more.
calpatientguide California patient rights, and much more.
CMS.HHS.gov Centers for Medicare/Medicaid Services. Includes nursing home ratings.
Medicare Medicare Information.
amdcanada Eyes. Amsler Grid.

Resource Description
MayoClinic Seems to have it all.
Merck The Merck Manual. The medical standard.
WebMD This and that, more...
drugstore Popular pharmacy.
pparx Prescription cost assistance directory.
HealthWorld Health answers, medline, more.
HealthLibray Stanford Health Library.
HealthAnswer Health/Medical answers.
InteliHealth Health/Medical answers.
MedExpert Has every medical link on the planet, more....
healthgrades Research hospitals/physicians/more. Free & fee.
QualityCheck Hospital ratings, more.
nhcaa National Health Care Anti-Fraud Association.
FDA Food and Drug Administration.
NLM Federal National Library of Medicine.
alz.org Alzheimer's info.

Resource Information About Specific Doctors
A.M.A. The American Medical Association. Basic background info and a whole bunch of other stuff.
A.B.M. Specialties Board certification status.
Admin. in Med. Misconduct, malpractice, criminal data.
A.D.A. American Dental Association.
doctoroogle The Good Dentist Guide - By Patients for Patients.

Hi, all. I do my best to keep this page current. If a broken link shows up here, please let me know via the comments section.

This Has to Stop

Last, but not least, Here is a page dedicated exclusively to patient financial victimization.