When it comes to overseeing the health care needs of others, it is difficult to be vigilant without being a pain in the ass. This was the case with Advocate. Prior to 2003, I had spent years fighting to get the appropriate health care for my folks. The fight included using the Medicare managed care Appeals process, which I successfully navigated in the late 90s. After that, obtaining the proper health care for my folks became somewhat easier. That was until 2003.
Advocate Health Care personnel did so many heinous things that it is difficult to say what was the worst. However, the following would have to be among the worst, especially because it was so...diabolical.
In 2003, my mother, stepfather, and I all had serious health issues. Mine included having a heart attack and needing quadruple heart bypass surgery. However, I did not have insurance, so it took a few months before I found somebody who would do the surgery. The tentative date coincided with the sub-acute physical therapy that my stepfather had been receiving after he had surgery in June 2003.
I had been in constant contact with the Advocate attending physician and nurse who were supposed to be coordinating his PT at Chicago's Warren-Barr Pavilion, a skilled nursing facility. He had been admitted there in early July 2003, and was scheduled to have the PT for at least eight weeks.
My stepfather was supposed to receive a treatment with a nebulizer twice a day or as needed during his stay at Warren-Barr. He was not given this treatment until after he had been there for 3 weeks, and then he only received it a couple of times. His prescribed diet initially consisted of pureed food...mush. Since he had had surgery on his neck, there was concern about him swallowing properly. The diet was supposed to be switched to that of a normal diet within a few weeks after arriving at Warren-Barr, but most of his meals remained pureed, despite repeated reminders to the kitchen. He didn't have much of an appetite for this slop, so I started bringing food in from the outside when I saw him.
My stepfather received physical therapy about 5 days a week, but not at any specific time. There was not any specific length of time for each session either. I was not able to be with him everyday, but for a while, another family member stayed with him, and she said that there were days when he did not have PT at all. He never regained his strength or weight while at Warren-Barr.
I spoke with Nancy Meyers, the Advocate nurse attending to my stepfather, about this. At the beginning of August 2003, she mentioned that my stepfather was not doing well in therapy, and that he would probably have his benefit suspended soon. My bypass surgery had already been postponed several times by this point, and I told Myers that it was important for me to know when my stepfather would have to leave Warren-Barr, so that I could make plans for his care while I was recuperating. If my stepfather had been able to assist himself, there would not have been a problem in having him come home. However, Myers had been saying that he may never walk again, and so he needed somebody to care for him while I recuperated. (for example, I was not supposed to lift anything heavy so my chest could heal.)
I spoke with Nancy Meyers, the Advocate nurse attending to my stepfather, about this. At the beginning of August 2003, she mentioned that my stepfather was not doing well in therapy, and that he would probably have his benefit suspended soon. My bypass surgery had already been postponed several times by this point, and I told Myers that it was important for me to know when my stepfather would have to leave Warren-Barr, so that I could make plans for his care while I was recuperating. If my stepfather had been able to assist himself, there would not have been a problem in having him come home. However, Myers had been saying that he may never walk again, and so he needed somebody to care for him while I recuperated. (for example, I was not supposed to lift anything heavy so my chest could heal.)
I was finally scheduled for my surgery to take place on August 20, 2003. On August 18, 2003, I spoke with Myers about my stepfather and his progress. I asked her what the earliest date would be when he would have his PT terminated. She told me August 29, 2003 (eight weeks from when it started).
My August 20 surgery was again postponed...on August 20. Advocate had no way of knowing this. That morning, I received a call from a friend whose number I had given out for emergency purposes. Somebody from Warren-Barr had called him and had told my friend that my stepfather's PT was going to be terminated on August 22, 2003, and they wanted to know where my stepfather would be going. After hearing, this I immediately called Dr. Rajan Raj, his surgeon, and he told me that the PT that my stepfather had received had not been adequate. I asked if he would put that in a letter, and told me that he would. (However, it took about four months before he wrote one.)
My August 20 surgery was again postponed...on August 20. Advocate had no way of knowing this. That morning, I received a call from a friend whose number I had given out for emergency purposes. Somebody from Warren-Barr had called him and had told my friend that my stepfather's PT was going to be terminated on August 22, 2003, and they wanted to know where my stepfather would be going. After hearing, this I immediately called Dr. Rajan Raj, his surgeon, and he told me that the PT that my stepfather had received had not been adequate. I asked if he would put that in a letter, and told me that he would. (However, it took about four months before he wrote one.)
The next thing I did was to call the insurance company's Expedited Appeal phone line, and I appealed the pending termination of my stepfather's PT. I stated that since he could not even walk or stand up under his own power, that terminating his PT would adversely affect his health. I asked for an extension of the Appeals process to 14 days, in order to give time for me to obtain the surgeon's input.
No action regarding the termination of my stepfather's PT should have been taken until a decision was made in response to the Expedited Appeal. Since there is no guarantee that we would have had a ruling in our favor, we risked having to pay out of pocket for any additional time that he stayed at Warren-Barr while not being covered by insurance. However, he was being shorted one week anyway, so we should have succeded in having the termination delayed for at least a week.
At the same time, the Advocate attending nurse, Myers, told me in a telephone conversation, that the decision to terminate my stepfather's PT had been made on August 19, 2003, during the scheduled weekly meeting to review his case. The conversation was bizarre because she denied telling me that the earliest that he would have his services terminated would be on August 29. Furthermore, I asked her for copies of the meeting notes, and she told me that there weren't any. She also told me that she had not heard anything about my filing an Expedited Appeal.
Things were not going well at all, and I did not have the luxury of being able to sit back and analyze the situation. I arranged for him to be placed in another nursing home. He was transferred there on August 22, 2003.
The next thing that I received regarding the Appeal was a September 8, 2003 letter from the HMO stating that the Expedited Appeal had been given to "Quality Management". My subsequent phone calls to the Grievance and Appeals Department went unanswered. My Expedited Appeal had been misclassified as a Grievance. The only thing required of the insurance company in response to a Grievance, was to do an internal investigation. It does not serve the same purpose as an Expedited Appeal.
It turned out that Advocate had informed the insurance company that I was simply unhappy with the PT that my stepfather had received, and that I had been in denial about his negative prognosis. This deception is why the insurance company classified my Appeal as a Grievance. Grievances deal with quality of care issues.
The sleazy charlatans of Advocate really out did themselves this time. First, they lied to me about when my stepfather would have his PT terminated. Then they waited until the day that they thought that I would be having quadruple bypass surgery to make the announcement that two days after my planned surgery, his PT would be terminated.
The cancellation of my surgery, foiled their plan to avoid me appealing the premature (by a week) termination. However, they still managed to dodge the Expedited Appeal by lying to Advocate about my motive.
If this is hard to follow, it is probably because one might have a hard time comprehending that a faith based non-profit organization such as Advocate Health Care, the largest in Illinois, and one of the biggest in the country, could be so inhumanely ruthless.
But they are!
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Note: As I have written in a previous post, Advocate has refused to provide us in writing with the criteria and rationale, specific to my stepfather's case, that was used in deciding that his sub-acute PT be terminated. They are required to do so by Medicare regulations. Instead, a year or so later, Dan Schmidt, then the President of Advocate, had one of his assistants send me some generic CMS classifications about skilled nursing facilities. Former CMS manager, Bette Weisberg, allowed them to get away with this act of contempt toward us.
