What Gives You the Authority? (Part I)

One day, several years ago, I called Medical Answering Services (MAS), which has the contract to dispatch Medicaid transportation in a lot of NYS counties, and I asked for a ride to my doctor.  The MAS call-taker responded with “What are you going there for?”

Say what?

You are asking me what treatment I will be receiving at the doctor’s?  Oh no, no, no, babe—you are not invading the privacy of my relationship with my doctor.  A minimum-wage, high-school-dropout, telephone-answering person is demanding that I tell her what treatment I’ll be getting at the doctor’s?  What about HIPAA?  What about confidentiality?  What about privacy?  Can’t you just hear some guy telling the girl that he’s going for a prostate exam?

Here’s the thing:  people out there are bawling about how us poor folks get all these free things, but they are absolutely clueless about the price we pay.  We pay with disrespect, invasion of our privacy, and being ordered around by people little intelligence and less life experience.  You try living with that week after week, month after month, year after year, and see what kind of miserable, defensive, hostile snot you turn into.

Well, by now you know me and you know I won’t put up with this, so I start making phone calls and asking questions.  What I find out is that some patient called MAS for a ride to her doctor.  The patient was reading aloud from the doctor’s business card, which listed psychiatry, neurology, sleep disorders, and acupuncture.  Three of the four are covered by Medicaid but acupuncture is not, so the call-taker set in motion a chain of events which resulted in every patient being asked every time what they’re going to the doctor for.

What is wrong with this picture is that it is none of Medicaid transportation’s damn business.   Doctors are very conversant with what Medicaid will and will not pay for.  It is their job to not provide anything that is not covered by Medicaid.  Doctors spend a horrific amount of time trying to downgrade their treatment of the patient to meet the level of the patient’s insurance, be it Medicaid, Medicare, or Blue Cross Blue Shield Platinum.  The doctor knows jolly well that he is not allowed to prescribe what is best for the patient but only what the insurance will pay for.   The doctor has ten thousand treatment modalities at his disposal and he only provides those that are covered by the insurance.  To do otherwise would be Medicaid fraud.

But Wayne Freeman, co-owner and operating director of Medical Answering Services, has taken it upon himself to screen treatment options at the point of transportation. It started with one ride to one doctor then Freeman told me that he intended to expand it to all rides to all doctors.  All patients would be asked what treatment they would be receiving.  This is where the abuse of power begins:  one man overextends himself and nobody stops him. Nobody’s watching this guy or monitoring his actions, and he does not set appropriate boundaries for himself.  So I filed some complaints, did some investigating, and nothing came of it.

Freeman has put a note on my file that his call-takers are not to ask me any questions, however, there’s a very high turnover of employees at Medical Answering Services—either that or it is an enormous organization–because you rarely talk to the same call-taker twice.  Some of the newbies don’t read the computer note and do ask me questions, so another occasion came up in which I was asked what I was going to the doctor for.  Hey, I don’t even tell my mother—do you?  Is there any reason why I should be treated differently from you?  Just because I am poor, does privacy not attain?  And keep in mind that if I give the “wrong” answer, then the high school dropout with no medical training will prevent me from accessing my physician.  And you want to know why poor people hate “the government,” i.e., those who abuse their power?  Go occupy something, why don’t you?

My standard answer is “It is none of your business why I am going to the doctor.  He is a registered Medicaid provider, I am a registered Medicaid recipient, and your job is transportation.  Please transfer me to your supervisor.”  So we went around again, and again nothing happened.

A week ago Monday, the dorkhead call-taker asked me the question again:  What are you going to the doctor for?  I gave him my standard answer, then spoke to the supervisor.  My question was singular:  What gives you the authority to ask what treatment I’ll be receiving? 

Notchaca, the supervisor, gave me some gobbledygook answer about the need to screen for appropriateness.

No, I said, what gives you the authority?  Show me, in writing, where it says you have the authority to invade my privacy.

Notchaca tells me it comes from DOH [the NYS Dept. of Health].

Okay, I say, mail me a copy of the directive.

No, Notchaca says, she’ll contact DOH and have them send it to me.

You have the information, I say.  Why don’t you send it to me direct?

Um, no, Notchaca says.  It would be too hard to find.  She’ll get it from DOH.  Notchaca says she will have them email it to her and she will land mail it to me and I’ll have it within three days.

After I hang up, I email Greg Allen, the DOH head financial guy who makes decisions about things like Medicaid transportation, and whom I met in a small, private meeting in Syracuse about the future of Wayne Freeman and Medical Answering Services. 

“Dear Mr. Allen,

“Would you please be so good as to tell me what it takes to get a straight answer from your department?

“When I try to place a ride order, Medical Answering Services (MAS) asks me “What are you going to the doctor for?” I maintain that this is a gross invasion of the doctor-patient relationship and my right to privacy. MAS says that they are screening to make sure the services are covered. That is not transportation’s business. It is the business of the doctor not to do anything that is not covered by Medicaid. If the patient and the doctor both have valid Medicaid status, then transportation should transport without any further questions. . .

“I repeatedly have asked for and not gotten clarification on this. Today, MAS has told me that the question is a DOH requirement. If that is true, then I want to see the DOH document that authorizes it. Preferably, fax it to me (phone first).”  [To be continued]

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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3 Responses to What Gives You the Authority? (Part I)

  1. Kate says:

    What will happen? Am on pins and needles! Is our fearless heroine is on the ropes!?

  2. Ken says:

    I’m just going to take a wild guess that you got this squared away, eventually. [Damn right I did, she says.]
    Little people with a little power are sometimes worse than world leaders with a backyard of bombs, it seems to me.
    Over here in Shanghai, my wife (a native) says there is a way of thinking that lets she and her compatriots survive without going insane under the government’s pressure. She says they say “Let the law be the law, and let China be China.” That translates, in your case, to giving an acceptable answer to the inquiry, even if it has no relation to the truth. It seems they tell the honest truth to their family, but everyone else — not so much. It’s fascinating.

    • annecwoodlen says:

      I have always understood a lie to be the utterance of a coward. That is, until I heard a reputable professional matter-of-factly lying to a government employee. He was doing it to get what his client needed. Apparently there is a category of lying that is about making the bureacracy do what it’s supposed to do but is too screwed up to do. Even so, I have a hard time lying.

      When I was growing up, my grandmother still lived on the farm from which–hundreds of years earlier–my ancestors departed to fight and die in the Revolutionary War. We did not die for this. I will tell the truth–even when government employees are lying to me–and I will fight unceasingly to make “my” government do what it’s supposed to do.

      An American President made a speech in which he referred to the people’s freedom “being in the hands of the least petty officer.” (Unfortunately, the President was Richard Nixon, but he apparently had a good speech writer.) Those “least petty officers” are a bitch.

      See the next post for the end of the story.

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