Diabetes & Endocrinologist

This letter is to respond to the complaint of *** *** *** *** came in to our office on 01/29/to pick up an order for labsOur protocol is a patient must have labs done prior to their office vista so that when the doctor sits down with them he has a better understanding as to what
their blood levels areOn the day *** *** came in I noticed patient had Driscoll Mediciaid which is a HMOThis basically means we need authorization from her insurance company in order to see herThe authorization Is generated through the referring doctor (*** ** ***) from the InsuranceI also noticed that she would be traveling from Sandia about an hour awayI Informed the patient that if we didn't have authorization on the day of the appointment we would not be able to see herI also asked the patient not to do the labs unless she was certain that an authorization had been obtainedOn Thursday 1, February while preparing the charts for the following day, I noticed *** ***'s authorization had not arrived, I called patient to inform her and she stated that she's spoken to referring doctor's office and they would be providing itThe following morning I checked in the Driscoll portal to see if authorization had been obtained and although an authorization was generated it was generated for the wrong procedureThe authorization that was on file was for a non-Imaging Heart Function and not for an Office Visit ConsulatationI once again called the patient and informed her that the authorization on file could not be usedI also called Driscoll Health Plan to see if the authorization could be corrected of if we could use it with the incorrect codeDriscoll's representative said I would not be able to use It nor could I correct itThe correction would have to be submitted from the referring doctorI then called patient to and informed her.*** *** showed up for her appointment accompanied by her mother and a childI informed the patient she did not have authorization for the appointmentBefore *** *** could say a word, her mother became very irate and said in a threatening manner, "Oh you will see my daughter!" When I tried to explain situation, the mother became angrier started using profanity and started yelling at meAt that point our Head Medical Assistant told her to calm down, that there was no need yelling or foul languageEven after the initial warning the patient's mother continued yelling and continued using profanityThe Head Nurse did give another warning to the mother (not the patient) if she continued being disruptive we would have to call the Police to escort her out of the buildingAgain the warning was given to the Mother and not the patient (*** ***)I called Driscoll again to see if an authorization had been corrected or if the referring doctor had submitted a new oneDriscoll's representative said there was no other authorization on file and the one that was on file was had not been corrected, therefore we would not be able to see the patient using their insuranceI had the representative from Driscoll explain to *** *** why she wouldn't be seen and also to explain her options

This letter is to respond to the complaint of *** *** *** *** came in to our office on 01/29/to pick up an order for labsOur protocol is a patient must have labs done prior to their office vista so that when the doctor sits down with them he has a better understanding as to what
their blood levels areOn the day *** *** came in I noticed patient had Driscoll Mediciaid which is a HMOThis basically means we need authorization from her insurance company in order to see herThe authorization Is generated through the referring doctor (*** ** ***) from the InsuranceI also noticed that she would be traveling from Sandia about an hour awayI Informed the patient that if we didn't have authorization on the day of the appointment we would not be able to see herI also asked the patient not to do the labs unless she was certain that an authorization had been obtainedOn Thursday 1, February while preparing the charts for the following day, I noticed *** ***'s authorization had not arrived, I called patient to inform her and she stated that she's spoken to referring doctor's office and they would be providing itThe following morning I checked in the Driscoll portal to see if authorization had been obtained and although an authorization was generated it was generated for the wrong procedureThe authorization that was on file was for a non-Imaging Heart Function and not for an Office Visit ConsulatationI once again called the patient and informed her that the authorization on file could not be usedI also called Driscoll Health Plan to see if the authorization could be corrected of if we could use it with the incorrect codeDriscoll's representative said I would not be able to use It nor could I correct itThe correction would? have to be submitted from the referring doctorI then called patient to and informed her.*** *** showed up for her appointment accompanied by her mother and a childI informed the patient she did not have? authorization for the appointmentBefore *** *** could say a word, her mother became very irate and said in a threatening manner, "Oh you will see my daughter!" When I tried to explain situation, the mother became angrier started using profanity and started yelling at meAt that point our Head Medical Assistant told her to calm down, that there was no need yelling or foul languageEven after the initial warning the patient's mother continued yelling and continued using profanityThe Head Nurse did give another warning to the mother (not the patient) if she continued being disruptive we would have to call the Police to escort her out of the buildingAgain the warning was given to the Mother and not the patient (*** ***)I called Driscoll again to see if an authorization had been corrected or if the referring doctor had submitted a new oneDriscoll's? representative said there was no other authorization on file and the one that was on file was had not been corrected, therefore we would not be able to see the patient using their insuranceI had the representative from Driscoll explain to *** *** why she wouldn't be seen and also to explain her options