Dora had success
I got an email from my friend, Dora. She moved to Germantown (the Philadelphia neighborhood where I live) from an outlying area, so changed doctors to be closer to home. She’s younger than I am, and doesn’t have the same hangups about phoning, so she called around.
She called a place in Germantown (I’ll have to get the name from her) and they told her that they have experience with deaf patients and asked if she needed an interpreter for the appointment. This is the way it’s supposed to be! A medical office gets a call from a deaf patient and asks if they need an interpreter, not the rigamarole I normally get where the receptionist tells me they don’t provide interpreters.
But when I was looking for Betty’s new doctor, nothing came up in Germantown, so they must not accept Keystone 65 insurance.
Followup on doctor
I’m catching up. Over Christmas, first Betty got sick with a bad cold, then she gave it to me. Now, it’s the middle of January and I’m still catching up with everything that I didn’t do while making Xmas gifts and recovering from our colds.
We both like Betty’s new doctor. He has a practice where it’s just him and his wife operating from an office in their home. I told him about all the troubles I’ve had with doctors ignoring me; and problems finding out how to get an interpreter for Betty’s appointments; and the resolution, that Keystone 65 gave me a number to call to request the interpreter myself for any appointment. He was glad that Medicare/Keystone 65 pays for the interpreter and was honest– with the amount of debt he has he can’t pay for interpreters himself from the practice. And I believe him. Which is why I’m not putting his name on here.
He renewed all of Betty’s medication, and she’s back on the Lovastatin. We have an appointment for next week where he’ll take blood for the test to see if her cholesterol is going down (he takes it himself, doesn’t make us take a separate trip to a lab, how nice!). We’ll go from there. So far, things look good.
Hope this goes well
I haven’t posted because Christmas is nearing, and I’m busy with things. But I did make an appt. with a new doctor, called Keystone 65 myself to request an interpreter. Appointment is today, and we’ll see how it goes. Keystone was supposed to call me to confirm they got the terp, but no call. Well, the message is “missed call from unknown caller, person hung up.” Caller is unknown because they’ve hid their nbr, so no clue who called; missed only means I wasn’t on IM when they called; hung up means they probably didn’t understand what was going on when relay answered and said the person they are calling is deaf.
Just pick one
In my last post, I wrote, “My next dilemma– do I make an appointment for Betty with one of the doctors who have ignored my faxes? Or do I just make an appointment with someone I haven’t contacted and hope for the best? If I choose to bypass those that have ignored me, then I’ll give them the impression that if they ignore the problem of deaf people, we will go away. I don’t want to reinforce that idea. But I really don’t want to go to a doctor who doesn’t want me.” I received a fax today from Betty’s old doctor that made me decide on a course of action.
I had sent a fax saying that Betty had been out of a medicine for over two months and wanted to know if it was more important to take the lab test to monitor her liver function, or to continue to take the Tenormin until a new doctor could order the test and make the determination to continue or change her medication. The fax I got back didn’t answer my question– it simply said that they were no longer Betty’s primary care provider and to find a new doctor. I have told Dr. Fedec and the folks at City Line Family Medicine several times to read this blog, but don’t know if they have or not. If they had, they’d know I’d been searching and have been ignored.
So, guess that now I know Keystone 65 will provide interpreters upon request of the patient, and we don’t have to go through the doctors (which I think is a bad idea, but I’m still mulling that one over), I will just pick a name from the list and make the appointment. I’ll pick someone I haven’t contacted before and see what happens. The recent experience with City Line Family Medicine has convinced me that I don’t want a doctor who doesn’t want me.
Still don’t know what to do about the doctors who have ignored me, though. Don’t want them to think that ignoring deaf people makes them go away.
Keystone 65 does pay for interpreters
Today, I called Keystone 65 and talked with Jim in customer service. When I first told him I needed to talk with someone about interpreting services, he asked me what I meant by interpreting services. To be expected– most people wouldn’t know if someone called them out of the blue. Jim spent a lot of time researching this, I was on hold for about 20 minutes while he found someone, Yvonne, to answer my questions. The result of this is:
- Yes, Keystone 65 pays for the interpreter
- The patient makes the request themselves at least two weeks in advance after they make the appointment with a doctor
- And I have a phone number to call member services and request the interpreter: 1-800-645-3965.
I’ve never seen a situation where the patient calls the insurance company to request the interpreter, but so it goes. I haven’t decided if I like it or think it’s a good idea or not. Have to give that some consideration. It does seem to be complicated, though. Here’s part of the transcript (through a IP-Relay service):
Me: I’d assume the doctor’s office must make the request ga
Yvonne (Keystone 65): no…thats something that member servies request for her, it goes to our outlets department to verify and then it goes through a process and then it get re authorized from there, if it gets reauthorized then it means it got approved
Me: this seems really strange to me I’ve always had the doctors office make the request. ok, so I just pick a doctor and make the request then, they don’t have any say so? ga
Yvonne (Keystone 65): as long as you’re going to a praticipationg provider, then that shouldnt be a problem, member services wouldnt mind apprioving your request.
So I guess my next step is to pick a doctor and just make an appointment for Betty, call to get the interpreter and show up and see how it goes.
For me, I’ve got plain Medicare, and don’t know if I can get Medicare to pay for an interpreter for me, or if the doctor has to do it. For me, I would have to get the doctor to make the request– I can’t get an interpreter then show up and expect the doctor to pay. Whoever is paying (or being reimbursed as I expect it is with Medicare) needs to arrange for the interpreter.
Sigh, more phone calls. I did ask if I could arrange for an interpreter online and was told no, had to call member services.
My next dilemma– do I make an appointment for Betty with one of the doctors who have ignored my faxes? Or do I just make an appointment with someone I haven’t contacted and hope for the best? If I choose to bypass those that have ignored me, then I’ll give them the impression that if they ignore the problem of deaf people, we will go away. I don’t want to reinforce that idea. But I really don’t want to go to a doctor who doesn’t want me.
I get “Life Extension” magazine (I am a member and buy products from them). In the Dec 2007 issue is a review of a book called Sick Girl by Amy Silverstein. In the interview she stated, “Doctors are only human and can make mistakes; they can like you or dislike you , and this can affect your treatment and care.” I agree and that’s why I don’t want to go to a doctor who ignores me. But I sure don’t want them to think they can get away with it. What to do?
Thanksgiving hiatus
Well, it’s the day before Thanksgiving and my search for a doctor for Betty and me is on hold. So far, the last two medical offices I contacted have ignored two faxes. So, I’m widening my search, to 8 miles from home instead of 5. Next to do is to call the other doctors’ offices and ask for their fax numbers and try again with them.
‘Tis not the season to be getting things done, though. People don’t have their minds on new work, new patients, etc. When I worked at the NAD (I was publications coordinator at the National Association of the Deaf), and we went from a monthly to bi-monthly publication, I came up with a weird schedule– we combined December and January issues when most people thought we should have had Nov/Dec and Jan/Feb issues. But from experience with the monthly publication I knew that it was hard to get volunteer writers submitting articles between Thanksgiving and New Year’s. So a Dec/Jan issue gets all the copy from the writers before Thanksgiving; and a Feb/Mar issue gets the copy from the writers just after New Year’s when they are feeling invigorated and ready to change gears. It worked well. I just hope that experience doesn’t translate to doctors offices and I can get a new doctor before the new year.
I’m grateful that I’m in relatively good health and don’t need a doctor right away. Betty seems to be okay, but I’m concerned. She had a triple bypass in 1996 and has been on medication since. She hasn’t had her Tenormin for a couple of months now, though. Dr. Fedec wouldn’t renew the prescription without a lab test to monitor her liver (which I understand), but I had already started looking for another doctor and didn’t see a need to go back to Fedec. I’m feeling pressured for time, though.
Winding my way thru the information maze
In my previous post, I put a link to the only info I could find online at Independence Blue Cross (IBX) about interpreter services. It’s for the adult basic manual, which doesn’t include Keystone 65 members; adultBasic is for people on both Medicare and Medicaid.
I called today (a 28 minute relay call), and found out that the doctor’s office does have to make the arrangements for the interpreter, and does that by contacting the “Provider Services” department of IBX. Seems the doctor doesn’t have to pay the interpreter and then get reimbursed– once they contact provider services, seems IBX takes over the process.
But, Marvin, the guy I talked with, said he only knows about adultBasic services. Keystone 65 is separate and he gave me a different phone number to call. I asked him if IBX had some kind of interpreter coordinator or someone who would know more about this issue, and he told me no.
So far, no help for Betty. Also waiting on responses from some doctors to my fax last week. Guess I’ll need to send them a second fax.
Who pays for interpreters?
According to the ADA guidelines, the doctor is responsible for paying for interpreters. The idea behind that is the interpreter is performing a service for the doctor, much as a CPA might. The cost is to be be assumed as overhead, regardless of the income from the deaf patient’s visit.
While at first, this has always seemed reasonable and right to me, I now think that it’s wrong… the insurance company should be the one to pay for the interpreters. I think that it sets up an adversarial relationship between me and the doctor if the doctor has to pay. After all, I selected them, they didn’t select me. And people refer their friends to their doctors. So it’s possible for one doctor to have several deaf patients, while another doctor in the same medical office building has none.
Kaiser Permanente functions as both the insurance company and the medical care provider. Their doctors are salaried employees and Kaiser pays for the interpreter, not the individual doctor or their office. In the hospital, too, the hospital pays for interpreters for patients, not the doctors. I think that’s why it’s easier (though still far from perfect in most cases) to get interpreters when hospitalized.
Now, I always thought that Medicare pays for the interpreter by reimbursing the doctor. Recently, I’ve been told that Medicare doesn’t pay for interpreters and now I’m confused.
According to the Deaf Doc, Carolyn Stern, http://www.deafdoc.org/ask/answerdisplay.php?id=60 the funding for Medicare reimbursement for interpreters is provided by the state, but the difficultly lies in finding out how the doctors can access those funds.
A couple of weeks ago, I searched Independence Blue Cross’s site looking for info on interpreters, and didn’t find any. Today, I found something (just put up or edited a few days ago):
http://www.ibx.com/htdocs/custom/adultbasic_manual/using_interpreter.html
That page says, “The Foundation offers adultBasic members interpreter services covering 66 different languages and dialects, as well as Certified Deaf Interpreters [sic] who translate American Sign Language. All interpreter services are provided at no cost to members and patient confidentiality is assured.” So, this means that Betty’s interpreters are covered by her insurance, right?
Maybe the doctors in the plan don’t know this.
In my experience, the doctor’s office must make the request for the interpreter. That’s only right, because they are the provider and it’s their responsibility. But the page above has new info for me– says that “An adultBasic member may call 1-800-464-5437 directly to schedule interpreter services for their doctor visit. Requests should be made at least two weeks before the doctor’s appointment.” That surprises me. I’ve never known of the the consumer, rather than the provider, making the request.
Being ignored because I’m deaf?
I’m very familiar with being overworked (and underpaid), not having enough time to in the day to get everything done, juggling priorities that change day to day or hour by hour. But when several doctors offices ignore me, or one doctor’s office ignores me repeatedly I am forced to assume it is because I’m deaf and they don’t want to deal with a deaf patient, or with paying for interpreters.
Yes, not everything bad that happens, happens because I’m deaf; and yes, people are genuinely busy and things slip through the cracks. But if it looks like a duck, sounds like a duck, walks like a duck… well, maybe it’s AFLAC, but it’s more likely it is a duck. So if it looks like oppression, feels like oppression…
Oppression:
Function: noun
[...] c : inequality of bargaining power resulting in one party’s lack of ability to negotiate or exercise meaningful choice —see also UNCONSCIONABILITY —op·pres·sive /&-’pre-siv/ adjective
-Merriam-Webster’s Dictionary of Law, © 1996 Merriam-Webster, Inc.
Thing is, I don’t think people are *trying* to oppress me. I don’t think it’s really about *ME.* I think it is their lack of training, knowledge, compassion, whathaveyou that creates this situation. I’m the one who suffers for it, though.
I’ve sent faxes to several doctors over the past two or three weeks and haven’t gotten a response from some of them yet. That, in itself, doesn’t concern me too much. Here is a concrete example, though, that makes me feel I’m being ignored because I’m deaf and they don’t want a deaf patient.
First, when I began looking, I saw that the search field in the local Blue Cross online (ibx.com — Independence Blue Cross, Betty is enrolled in their Keystone 65 Medicare plan) had an option for “language use” which includes sign language. But no doctor showed up when I used that in the search criteria. So I went to Revolution Health and found two doctors came up as sign language users. I faxed Nancy Jane Walker, and the office replied that she was no longer working there, she had moved to Lancaster. The second doctor, however, Rupal S. Kothari, has not responded to three faxes. I can only assume that don’t want a deaf patient for whatever reason (most likely that they don’t want to pay for interpreters, but there may be other reasons. I don’t know, they don’t respond to my faxes.)
Now do you see why I say that if it looks like oppression, feels like oppression… well, it probably is oppression.
I don’t know what rights doctors have in choice of patients. Does all of the choice belong with the consumer? Trouble is, I don’t want to go to a doctor who doesn’t want me.
Non-compliant, reasons have
Betty’s newly ex-doctor, Dr. Fedec, probably thinks we’re non-compliant– that we don’t follow up and do the things she wants us to do, make the appointments, go to the doctors that she refers us to. In a way, she’s right. I’ve done much of what she’s given us to do, but not others. What she doesn’t understand is why we’re not following up.
I’ve told her that I hate the phone, is there some other way to make the appointment? But invariably I have to call. That’s the first thing. The second thing is that I have to go through the rigamarole every single time I call a new office. The one I mentioned earlier– “Betty and I are both deaf and we’ll need an interpreter for the appointment.” “Oh, we don’t provide interpreters…” etcetera, etcetera, etcetera. This becomes very tiresome and draining when I have to do it EVERY SINGLE TIME I CALL. And of course, all my problems with calling through relay, as mentioned in several previous posts, apply here as well.
Add to that, that I only have a few hours in the afternoon to do this (night owl again), and I’m trying to work and earn some money and the afternoons are my prime hours to work.
As I mentioned in an earlier post, with Kaiser I could often get an appointment right away by going to the receptionist and asking if we could do that now. The times I couldn’t, and had to go home and call, I would be asked if I wanted an interpreter for the appointment by the scheduler before I had a chance to mention it myself. You could say I’m spoiled. But really, shouldn’t it always be this way?
