Dot your Ts and cross your Is

By Mir
March 31, 2005

I received one of those fake eBay scam mails today. I was urged to update my account, but cautioned “Never share your eBay password to anyone!” Dang… I was this close to succumbing to their nefarious plan. But I never give my credit card information to people for whom English is a second language, because I’m an elitist American snob.

Then I was reading along… somewhere… today (I can’t even remember where, but it doesn’t really matter), and a poster commented that they would skip any posts where the language wasn’t perfect, because they’re “really a stickler for proper grammer.” (sic) Cuz, you know, it’s so verry anoying when peuple dont have grammer skillz. I resisted the urge to reply “Pot, meet kettle.” Or that I’m really a stickler for spelling, and I’ve decreed that the original poster has been sentenced to death via multiple puncture wounds with red editing pens.

The devil’s in the details, as they say.

I did the final steps (I hope) of the Referral Shuffle today. Surely you’ve danced this dance, no? In the world of HMOs, there’s a fabulous trick to keeping costs down. Rather than just, I dunno, allowing medical professionals to make informed choices about a person’s medical needs, the goal is to send every person’s file into the endless loop of Referral Management until the patient either succumbs to the malady at issue or just loses the will to live.

I’m sure that if my HMO were a person, it would tell me never to share my password to anyone, and please input my credit card information right over here.

Anyway, Chickadee needs a referral to have this complete neuropsychological assessment done, because I’m the sort of overbearing parent who actually wants a diagnosis from these people who keep shoving sample packs of drugs into my hand and telling me that “maybe this will help.” (On the bright side, Monkey was delighted with the handful of Strattera pens he scored a couple of weeks ago when I noted “Oh, I see the drug fairies have visited you!” at the doctor’s office.)

In the HMO Referral Shuffle, the testing doctor refuses to put you on the schedule until you have a referral code (because insurance so often turns down these requests). The doctor’s office tells you to go through the referral office, and the referral office takes your information and wastes a few days before telling you that you need to go through the doctor’s office. The doctor’s office asks why you’re calling about this again, then stalls for a few days, and eventually calls to tell you to go through the referral office.

So today when I was told to go back through the referral office (again) after I’d explained the necessary procedure (again), the woman on the phone told me that was “all she could do for me.” And I took a very deep breath and as calmly as I could manage, I said, “You know, I understand that this is not your personal fault, but I’m really frustrated. In fact, I’m starting to get angry. My child is being denied service because your office can’t seem to figure out who should look at her case. Is this the kind of care you‘d want your child to have?” I paused to uncurl my free hand; I’d realized I was digging my nails into my palm. “Tell me what I need to do to get this done. Please.”

I claimed victory when she called me back an hour later with an official authorization number from the HMO. My celebration was short-lived, however. After speaking with the office that’s supposed to schedule her for testing, it was revealed that without more information (dates of service and number of visits authorized) the code was all but useless. I did get the doctor there to promise to investigate it on our behalf, though. So that’s something. I guess.

Tonight I saw my friend to whom I’d given a container of soup, earlier this week. I’d scooped the soup directly from the stock pot I’d cooked it in, into a plastic container I’d just removed from the dishwasher. My friend told me she was eating it for lunch today and found a staple. In her soup. We spent a good ten minutes trying to figure out if the staple came from my house or hers, and how could it have gotten into the soup, either way?

Sometimes I think all the details of life–the important and the inane, alike–are what cause people to end up in padded rooms.


  1. Suzanne

    I’m going through the VERY
    SAME EXACT THING with my son for the same testing! I haven’t written about it yet on my blog because I can’t get out of the corner…and all that comes out of my mouth is, “buh buh ba buh buh ba buh buh buh buh.”
    -hold me-

  2. Liz

    Good luck, Mir! You’re one tough cookie and I loves me a cookie ;o)

  3. joshilyn

    I think you deserve a medal for not strangling anyone yet. I feel VERY certain the REFERRAL OFFICE PEOPLE are all ex-DMV employees who got fired when they were caught hunched over in a back corner, fondling the red tape. BAD TOUCH, BAD TOUCH.

  4. Philip

    I would go back to your primary care physician’s office, call the person in charge of referrals and tell them your problems. They should be acting as your advocates in all medical matters. Any reluctance on their part to help would indicate just how little they want your future business (and it is business).

    I’m still scratching my head over the mystery staple. And why she would have even mentioned it – did she think you were trying to do her in? With a staple?

  5. Psycho Kitty

    Oh, Mir. I adore you. Hang in there, sister.

  6. Amanda B.

    Sometimes I staple splitpeas to my shirt for decoration. If that helps at all.

  7. Amy

    Oh, Mir. I feel your pain. It took me SIX MONTHS to convince my insurance company that I had, in fact, brought my children with me the last time I moved. They kept denying claims and insisting that the correct pedatrician was in another state HALFWAY ACROSS THE COUNTRY…oooh, I’m going back to the BAD PLACE, somebody help me…*whimper*

  8. udge

    “Proper Grammer”? Must be a “Frasier” fan.

  9. DA

    Nice blog. I enjoyed the visit.

    I won’t pretend to know what you’re talking about (specifics of the tests, etc), and I must preface-confess that I have testicles, so anything I say HERE maybe discounted. I DO have children, and I have been wondering what I’ll do when I grow-up a couple of decades longer than you, apparently.

    All that said, I don’t understand the patience and civility that you apply to your HMO/Medical offices challenges. Life is too short. I prefer to cause heart attacks rather than be the recipient of one.

    I suggest using your obvious writing talent to document the dates, TIMES, names, and specific details of every communication you’ve experienced in your patient and civil mannered attempts to get the assistance you are entitled to …

    send it as a CERTIFIED & RETURN-RECEIPT letter and address copies to: 1)The Saw-Bones (Doc), 2) the HMO 3) Your U.S. House of Representative’s office (with foot note saying that you are including her/his office to provide him/her with a sample of how the system is broken, out here in the real world, so that the next time he/she has an opportunity to vote on patient’s rights legislation, perhaps your example will help guide them). In that same trip to the post office, send the exact same letter to the exact same 3 via standard, first class with only a proof-of-mailing (.35 ea. additional). The reason for the duplicate via 1st class is so they can’t claim that they refused to sign for the certified, so they never saw it (usually only really-bad (reads: crooks) will resort to that tho). About 2-to-3-days after you return from that trip to the post office, FAX the identical copies to all 3 as well. Sounds anal as hell doesn’t it? Trust me, it breaks their cycle of patient-shuffle-nonsense like magic.

    I would intentionally leave off any copy to your employer’s human resources folks (even though they are the ones who shop for your available health insurance options and COULD be a last resort) lest they think you are a troublemaker immediately (hell, they might can you for blogging these days!) BUT, if such a certified letter does not evoke the anticipated level of cooperation (“certified mail” is a fabulously effective thing, in my own experience and does not cause any lasting damage to relations … “THEY” just know that YOU are a serious player not to be trivialized moving forward) I would, after waiting a sufficient period for a response, repeat the process and add a local MEDIA resource to the top of the list of addressees (that last step should be reserved for a total breakdown in communications and as a last resort in any event … coz it usually precludes any future “civility” between parties (incase you CARE about your Doc’s smiling bedside manner, etc (I don’t).

    When this “CERTIFIED & RETURN RECEIPT” letter thing was first suggested to me, I was skeptical … and the idea of spending 3-4 bucks per letter, and standing in line at the post office to mail letters seemed intolerable. But the advise came from a LOOOONG time friend / acquaintance (curmudgeon) who was law professor at a local university, municipal judge, and local ambulance chasing attorney that happened to look a lot like Matlock! And the very first time I employed the tactic, it worked slicker ‘n’ snot! Like magic really. My judge friend exlained that if something actually deteriorates to the point of requiring a legal resolution, certified & return receipt USPS is as good as gold in the court room. Like having Johnnie Cochran represent you (& he’s getting ever tougher to get). Besides, it has a unique way of breaking the cycle of the contrived administriva shuffles which are so often designed into today’s corporate dealings with customers and the public.

    Once they receive a letter with all those official looking markings the recipient knows that the sender has already braved the most complex and frustrating confusion ever designed by mankind … the U.S. Postal System, and thus anything they can throw your way, to inhibit your progress, would seem like mere child’s play after that. Surrender to your will soon follows! ;-)

    BTW, I got a similar e-mail about my PayPal acct. … if you like the idea of extracting a bit of justice (it’s one of my hobbies), the format of the e-mail addresses for such plishing to be pursued is: or “spoof” @, or wherever, etc. and for good measure you can include coz the Federal Trade Commission DOES actually enjoy pursuing the origins of such stuff. Just make sure that you include the FULL headers of the message when you forward it, and don’t add any commentary to the forward. You might be surprised at the personalized reply you receive in reply, form the commerical entity (not the FTC) … PayPal was very appreciative of my forward and sounded plausible and convincing in their promised investigation. If you get one from a zillionaire in Africa that wants to wire millions into your bank acct. forward THAT type here: that’s the U.S. Secret Service dept. that investigates those. ;-)

    Anyway, nice blog, great wrtiing, and good luck.

  10. DA

    Oops, I guess the e-mail addresses I left disappeared upon posting:

    they were:





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