The LA County Observer

Observations of a LA County Resident

Having to make your own way to get your care

Written By: raconte - Dec• 23•16
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You’d think that Adventist Health, you know that religious, hospital/healthcare corporation would do everything in their power to ensure that their employees who suffered a work-related injury would get care in a timely fashion. Unfortunately, that’s not been my experience, especially with what should’ve been my final surgery.

As I posted yesterday, I suffered a full respiratory/cardiac arrest just as the anesthesiologist gave me a nerve block. More than four months later, I’m still waiting for the follow-up care required after such a life-threatening event; but this delay shouldn’t come as a surprise since Adventist Health did nothing to get the medical clearances needed for my shoulder surgery.

After having to go to court to get the Adventist Health to approve my right shoulder surgery, I discovered that Ms. CA decided that before giving the surgeon the go ahead she had to run it by utilization review (UR), in case UR paper-pushers could find a “way-out” of having to provide the very surgery that Adventist Health had agreed in court to provide, I guess. UR, however, green lighted the surgery, including the hematology consult requested by the surgeon. So after this unseen delay, it fell to my daughter and I to make all the necessary appointments to get the requisite medical clearances.

Medical clearances are part in parcel prior to surgery and this is a generally accepted medical practice and standard of care Ah, but not so with Adventist Health. After scheduling the same hematologist that Adventist Health had used for an earlier clearance, I learned one day before my appointment that Ms. CA had denied the clearance. Not only did she deny the approval she told the hematologist’s assistant that my right shoulders wasn’t part of my Workers’ Compensation claim. So with the clock ticking and thanks to the help of Keck-USC where the hematologist practiced we were able to get my private healthcare insurance to cover the consult. Of course the whole point behind Workers’ Compensation is that your employer’s workers’ compensation insurance pays for all the care, direct and related, of the injured worker. Perhaps this isn’t the case with Adventist Health?

To be continued . . .

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