Saturday, May 16, 2009

Open Letter to CEO of Mt. Carmel CEO

This is: Claus Von Zychlin
President and CEO
Mount Carmel Health System

And this open letter is for him!

Dear Mr. Von Zychlin:

I want to bring some issues regarding my mother and her health care to your attention. According to your website you preside over:

the second-largest health care system in central Ohio. Our more than 8,000 employees and 1,500 physicians utilize state-of-the-art facilities, advanced technologies and the latest procedures to accomplish our mission of healing patients’ minds, bodies and spirits, and improving the health of the communities we serve.

I would like to point out that the 8000 employees you have are receiving substandard service and care from your Health Plan. I am going to tell you a story.

My mother has thyroid cancer. A rare form of thyroid cancer. One that has caused us to exhaust normal avenues, avenues within your system. Two very well respected doctors in YOUR SYSTEM agreed that she would need to seek care out of network. Here begins the issues. If we could get proper care in your system we would, trust me, we are not really having a good time struggling thru this minefield.

Aetna, your chosen provider, to act as administrator of your own self insured insurance plan in my opinion offers substandard customer service - to both the participants and the provider.

From the time of the 1st referral, almost 18 months ago up to and including yesterday visit to our Thyroid cancer specialist at OSU/The James, we have been treated shabbily and it has been a circus of phone calls upon phone calls, upon faxes and I wish the issues ended there.

The referring physician should not have to make multiple phone calls and be subjected to hurdle after hurdle. Sadly this has been our experience, the reps on the phone either cannot or will not listen and are unable (a training issue I believe) to think critically and ask appropriate questions. Under normal circumstance a specialist would not refer to another specialist - but this is not a normal circumstance. The reps need to be trained for both.

Furthermore, we should not have to start this process from ground zero each and every time we request a renewal, the referring physician should have a single point of contact to call. Someone trained to speak with highly trained and specialized physicians. Your providers deserve that and your employees also. As a client of Aetna - you should be demanding the highest level of service for your employees and your Medical providers.

In addition, we had approval to go to the hospital for some high level radiation and at the 11th hours something went wrong - there was a miscommunication. The reps at Aetna had not crossed their t's and that of course became our problem, which we had to involve two physicians and we almost had to scuttle this treatment due to YOUR insurances plan lack of attention to detail. That was embarrassing, my mother works for the 2nd largest hospital system in the city and their insurance plan is administratively substandard.

Whilst speaking of substandard let's explore your lab and film rooms inability to follow direct physician orders. Orders written in bold print on the form or prescription notice. As part of Aetna's approval for out of network treatment, we have to have all CAT scans and MRIs and Lab work addressed within your system. Which we understand, is a significant cost savings. It makes wonderful fiscal sense. IF YOUR SYSTEM COULD HANDLE FOLLOW THROUGH! The orders clearly state that the results are to be faxed to the physician ORDERING the test at OSU. Those labs and scans are useless unless they make it to the physician requesting them.

After a 6 week fight to get the approval to see the doctor yesterday, we get there and yep - no labs results and no scans and no notes from the radiologist who read the films. Are you kidding me? So we waited an additional 1 hour, while his staff tried to track them down at Mt. Carmel. How embarrassing. The lack of attention to detail is astounding. How can your labs and other departments be trusted to see to in-patient care when they are this sloppy with my mother's care?

I had both of my babies at your St. Ann's location. Going forward, I plan to seek care elsewhere. Your hospitals in ability to follow simply instructions is questionable. Your health plan is not customer/associate friendly.

I will say we involved KS in benefits and she did get a process outlined for us - for the doctor to use every time we need to get approval. I am not convinced that this is not going make the process smoother, I am not convinced that this is not going to once again be a pain, more stress than my mother needs. My mother is trying to be a committed employee and stay as healthy as possible.

Before you write this letter off as being from some writer who likes to read her own writing, I will point out I am 1/2 way thru my MBA and I spent almost 10 years at a large financial services company. I have sold benefit plans - I understand how the ins and outs work. I know that you are not getting what you pay for OR PERHAPS you are. Perhaps it is your hope, as a method of cost savings, that if you make this process SO INCONVENIENT that employees will just stop the process. The problem in OUR case - it would mean a death sentence for my mother.

I know medical insurance is expensive for both the employee and the employer. Containing costs is important - HOWEVER as a medical company - shame on you for potentially trying to cut costs at the price of your employees' health and mental well being - the same employees entrusted with caring for the community. The hypocrisy is appalling and I am writing this letter to make you aware. It is my hope that you take a role of leadership and DO SOMETHING TO MAKE IT BETTER for the very people who represent you day after day, shift after shift.

I welcome dialogue on at THOUGHT'S FROM THE EDGE, feel free to contact via this blog.

All the Best!

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