Patient Abandonment - Refusal to See an Established Patient or Refill Prescription

In My Humble Opinion
1

My apologies up front for such a long post.

I have been seeing a Psychiatrist since last October. I had 13 appointments with her at her previous office, and 3 appointments with her since she moved to a new office on May 1, 2017. Upon arrival for an appointment on July 24, 2017 (my 17th appointment) to get a refill for my medications, I was told by the front desk employee the doctor no longer takes XXX insurance. I asked her when they were planning on telling their patients about this. She stated that they were in the process of doing this, and I asked why I hadn’t been informed since I was there for an appointment, and was told “We just found out about it this morning - her old office lied to us, she never took XXX insurance.” I told her that was not true as I was a patient from her old office and all my appointments had been covered by XXX insurance. She told me I could still see the doctor that day for $XX (3 times my co-pay) and I stated that I could not afford that. Seeing the doctor for depression, anxiety and paranoia, I felt blind-sided and began to cry. I stated that I had an appointment to get a refill for my medication, and now I couldn’t even get a refill. She said I could see the doctor that day (at the price she quoted) to discuss that. I told her again that I could not afford to pay that price, and left. I thoroughly expected to get a call from my doctor to apologize for the non-communication, but I didn’t get a call. On August 2, 2017 I called the office to ask how I could get a copy of my records sent to me. The gentleman who answered the phone said he didn’t believe they would provide the records to ME, but I could come by their office to get a form to provide the records to another doctor. I asked him email me the form (which he did). While on the phone I stated that I would like to get a refill on my medications. He said he would ask the doctor and call me back. When he calledback, he said the doctor wanted to know if I planned on keeping my next appointment that was scheduled for August 24, 2017. I told him that since the doctor was no longer accepting XXX insurance, no, I would not be keeping it. He stated there was a “snafu” and the doctor DOES take my insurance. I asked again, “When did you plan on telling the patients who were told it was no longer accepted?” He said “We already did.” I said “Really, because nobody told me.” He laughed, and said “Sorry about that.” He said he needed to let the doctor know I was not keeping the next appointment and would call me back about refilling the prescription. He did leave a voice mail stating the doctor called in a refill. I have found a new Psychiatrist, but can not get in to see him until mid-October. I will need a refill on my medications before that. Seeing that I had not yet submitted the request to send my medical records to a different doctor, I called the original doctor’s office today to make an appointment to get a refill. When the woman who makes the appointments asked for my name I was put on hold. When she returned she stated “Dr XXX was under the impression that you found a new doctor.” I said yes, but I cannot get in to see him until mid-October and I need to get a refill for my medications." She said she would talk to the doctor and call me back. Her voicemail said “The doctor said that you will either need to wait for the new MD appointment or ask your PDP to write a script for you, that she will be unable to do so.” Can a doctor terminate their services/obligations to an established patient on the grounds that the patient plans on changing doctors?

2

I’m sorry you had to deal with all of that and I’m also sorry that I don’t know the answer to your question. It sounds like the doctor doesn’t have a very good front office staff. I got the impression the people in the new office tried to blame what sounds like their error on staff from the old office. I’d be interested in hearing from any doctors on the board if they have any idea how important a good front desk is to their business. As far as the doctor, my guess is she can do whatever she damn well pleases, but knowing your history as a regular patient and the reasons you are receiving treatment, I really don’t agree with how she treated you. It’s really a shame you can’t get time with her to explain why you planned on leaving, but of course, no insurance would pay for that. I would find someone new.

3

Stripping your understandably hurt feelings away, it looks to me like the doctor didn’t abandon you. Rather, she stopped taking your insurance. The staff informed you that you could continue to see her, but you’d have to find another way to pay. You then canceled your current and future appointments. Even then, your doctor still called in one more refill for you.

That sucks, but it’s also always been that way with doctors, particularly psychiatrists. They’re in a constant battle with insurance companies over reimbursement. When they can’t work things out, they stop accepting the insurance and their patients have to choose between paying more, switching insurance companies, or switching doctors. The exact same scenario happened to me more than 20 years ago. It would have been nice if my doctor had offered me a reduced rate, but his practice didn’t do that, and I had to move on.

4

Talk to your internist or “Primary Care” physician. Explain the problem and bring your old prescriptions, or the bottles. Most will willingly fill the prescriptions until the next Psych appointment.

I do feel your pain though. It is incredibly difficult to get an appointment, and then when you do, many want to see you a few times before they will prescribe. They really don’t seem to care that you arehigh and dry in the meantime. It’s disorienting.

5

Thanks for your reply! I probably needed to clarify better that the doctor actually never stopped taking my insurance. The office staff erroneously told me the doctor stopped taking it, and then never reached out to me to correct that. Therefore, with the last info I was given, which was that my insurance was no longer being accepted (which was wrong information), I needed to find a new doctor. I am considering sending her a quick note letting her know the circumstances of why I felt I had to find a new doctor. I have a feeling her staff is not being honest with her.

6

That is not true about being able to get copies of your medical records ! I done this a numbers of time ,I had to sign a release form to get my records. You have a right to see what in your medical records . It does cost money some time if it on a DVD disk . If you’re moving to another state and don’t have a doctor you needs to have copies of medical records . You don’t want to wait 3 or 4 weeks to get it in the mail.
Some doctors will give their patients samples of meds they get for free if they can’t afford to pay for it . This really sucks the way you treated and I am disgusted that happen to you . Do you have a case work that can help you ?

7

I thought the OP said he was later told the office did take his insurance. It sounded like a big mix up, but no one informed him they had stopped taking it prior to him showing up and then no one had notified him it was a mistake and they did take it.

8

I thought you explained perfectly. I also think a note couldn’t hurt. Good luck, I hope it all works out for you!

9

Sorry, Say what?. It sounds like the medical system — and especially one particular doctor — failed you.

My problem, related to part of OP’s, was more trivial but I’ll tell it because it may be amusing.

When I moved to Thailand I wanted my medical records and was told the exact same thing. I had my “Doctor” friend (PhD) mail them a letter asking for MY records. They gave them to HIM even though
[ul][li] His letter came with NO authorization whatsoever from me,[/li][li] He probably didn’t use the right diction to for the letter to appear to come from an MD.[/li][li] Obviously he enclosed no proof of his Doctorate.[/li][/ul]
Think of it! They wouldn’t give MY medical records to ME, but they gave them to a total stranger impersonating a doctor, with no authorization from me. True story.

Punchline: It was only when I finally viewed the records that I learned doctor had diagnosed me with Irritable Bowel Syndrome. He never told me my diagnosis! (Perhaps he informed my “primary physician”, but that was just some MD I paid $40 to to get the required referral to this supposedly top-notch doctor.) My symptoms were so horrid I assumed I had colon cancer and had been paying for expensive tests.

Once I learned the name of my condition, I consulted The Merck Manual. Guess what the very first sentence under Irritible colon:Treatment in that Manual is:

The patient should be reassured that his disease, though discomfiting, is not serious. The problem must be explained to him, …

I don’t think you’re calling OP and myself liars. Are you suggesting we should have hired lawyers to pursue our rights to medical records?

10

That’s true - but it’s also true that the doctor never refused to see the OP while the OP wanted to continue the doctor-patient relationship. The OP did not keep the appointment on July 24 because of the insurance issue (understandable, but not the doctor refusing to see the OP ) , and told the staff that he/she would not be keeping the appointment for August 24 ,even after being told the doctor did in fact accept the insurance. The doctor called in a refill at that time and now the OP, after telling the office that he or she was going to find a new doctor wants another appointment for a refill - after confirming that he or she will be changing doctors and needs the refill only because the new doctor has no available appointments until October.

I'm not going to opine on what the OP should or shouldn't have done- but I wouldn't "fire" a doctor twice and expect them to see me one last time because I can't get a appointment with the replacement quickly enough enough.  And that's another part of what keep this from being patient abandonment in my opinion - the OP very clearly communicated that he/she was ending the doctor patient relationship by finding a new doctor. Things may have gone very differently if the appointment on Aug 24 was kept after finding the doctor does take insurance. Or if the answer yesterday was "I've changed my mind and will be staying with Dr XXX".
11

AFAIK, yes. Generally, though, doctors who are going to drop patients send a letter.
I would report the doctor to his or her state professional organization, as well as to the appropriate state physician oversight board. It can be dangerous to suddenly stop certain medications.

Also, try to get in to see your primary care doc, let them know your other doc dropped you, and ask for a month’s refill to tide you over until the appointment with the new doc.

ETA: patients have an absolute right to their records, though offices will likely charge for photocopying/printing. Report that to the state board as well.

12

It sounds like the person who told you that the doctor no longer accepts your insurance either erred, or was misinformed. It also is quite possible that the doctor herself has little knowledge of the fact that you twice cancelled appointments, and that you are seeking out a new doctor, solely because of interactions with her back office staff. You cannot assume that her staff faithfully relayed your conversation, including the fact that you left in tears, because it would make them look bad.

No, all the doctor may know is that you keep cancelling appointments, once on the day of the appointment (meaning irrecoverable loss of income to her), that you are planning to move to a new doctor, and that you keep asking her to jeopardize her license by continually asking her to refill psychotropic medications without the requisite counseling.

While it makes sense to me why you cancelled the 7/24 appointment, it makes no sense why you canceled the 8/24 appointment, since it was after you were told that she did, in fact, accept your insurance. You must know that these appointments are required. And you must also have known that there was no way you could get into another specialist before your next refill was due. So you have to accept some of the blame here. If she abandoned you, then you also jumped ship prematurely.

Either way, you know now that you cannot get into the new doc until October, and your current doc won’t write a prescription without a visit. So you have two choices:

  1. Take her advice and go to your PMP for gap coverage.
  2. Ask this doctor to call you asap so that you can explain what transpired, and give her an opportunity to respond. At the very worst, you’ll come away with a game plan for obtaining gap coverage, which may include seeing her again. At the very best, you’ll get a heartfelt apology, and may even end up staying.

But I want to stress that IF you were happy with her as a counselor, and felt that you were making good progress, you should try option 2 first. She wouldn’t be the first competent professional who was sabotaged by incompetent staff. Don’t allow them, or your ego, to jeopardize your mental health. Any doctor can write prescriptions, but that hardly means they are interchangeable. If you have good chemistry with this psychiatrist, and if you were happy with her up until 7/24, you owe it to her and yourself to give her a chance to make it right.

If you weren’t happy with her for other reasons, then by all means take option #1

13

According to Nolo, you’ve got a right to your own medical records under US law, though there are certain exceptions - notably psychotherapy notes (which could be what the OP is running into). Ironically in your case one of the exceptions is for information that could endanger the patient or someone else’s safety - when the information in yours was exactly the opposite. Tricking the office into releasing them is probably much better than hiring a lawyer in your case though.

14

[quote=“doreen, post:10, topic:793285”]

That’s true - but it’s also true that the doctor never refused to see the OP while the OP wanted to continue the doctor-patient relationship. The OP did not keep the appointment on July 24 because of the insurance issue (understandable, but not the doctor refusing to see the OP ) , and told the staff that he/she would not be keeping the appointment for August 24 ,even after being told the doctor did in fact accept the insurance.

15

I must not have written my post in a way that was self-explanatory. I was not told that the doctor did indeed accept my insurance until after I said I would not be keeping the next appointment. I did call to make an appointment to see the doctor to get a refill on my medication - an appointment, not a phone request to get a refill.

16

Upvote.

17

I don’t understand. Are you saying that now you plan to keep the appointment for August 24? Did the office cancel it after your conversation in July and then refuse to give you another appointment (either to reinstate Aug. 24 or for another date) after you asked them to? Did you make it clear you don’t want to change doctors now that you’re sure the first doctor accepts your insurance?

18

That may be true, but you did have an opportunity to recant the cancellation once you learned that she did accept your insurance. That rather absolves her of the “She is refusing to see an established patient.” claim because it was you, not she, who cancelled the 8/24 appointment.

That doesn’t mean that she shouldn’t work to make things right. Please pick up the phone and communicate with her directly.

19

Most doctors do not answer phone calls directly, but direct office staff to do so. I have the need to call, on average, 25 doctors a week. I speak to the actual doctor (or nurse practitioner) maybe once every 3 or 4 weeks.

20

Of course the doctor doesn’t usually answer the phone. She needs to ask to have the doctor call her back.