Social Workers; Psychologists; Psychiatrists; MDs Beware!

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   The Shamanposted 15 years ago

   Hello - to give a little background about myself - I am a Social worker; a Psychologist and a Christian Minister by trade. I am also into holistic medicine. For nearly all of my life I have enjoyed counseling and helping others in the primary Psychotherapy profession for many years. I have over 25 years of experience in the area and working with others from diverse persepectives leading up to my private practice. I am also a composer; artist and musician. I am known as The Shaman. I enjoyed my practice up until September 2009. Out of the 3,000 clients I have served, and their families from all walks of life I have never come across this level of terrible experience in practice than the one I have recently gone through from the mind of one Patient that I have tried to help - a Patient whom I have only seen four times, but nevertheless took time with. A month later after we seen her for the last time we got a Certified Letter on Saturday from Optim Health and another one the following Saturday after that regarding a surprising complaint from a surprising source. You see we had taken our time with this memorable Patient; we took time to listen to the issues; gave the objective feedback; done the extensive documentation and included the signature pages and even had eye witnesses of the presence of the same Patient coming to my office, then two months later this same woman filed a false claim that she was not seen by me - at first for all four sessions - then three - then for two. In respect for the complaint the Insurance company asked for documentation and so we complied immediately. Despite the submission of notes;documentation; signature pages and so forth Optim Health's Investigative Team unilaterally sided with the Patient who has some serious issues surrounding the need to control. The Patient even bragged to me about her control over the investigator the case was assigned to this case stating that she is her ''b..tch'' more than once; this sentiment was shared with UBH/Optim Health and they still backed the hasty investigator's prejudiced decision. We recalled the only two conversations we had with this clueless senseless investigator who has no clue of the kind of work we do; no appreciation and has not respect for mental health professionals and she was found to be well armed with a jaded attitude against all doctors; social workers and psychologists thinking that only the Patient is right in all case desputes.  She lacked understanding of the seriousness of the work and the kind of diverse people we encounter. She fails to understand that not of us are automatically frauds and white collar criminals when a someone files a claim against us. Some of us are honest hardworking dedicated people. I have sustained over a month of certified letters, the last one from them I refused to sign over $40.00 dollars and there is no guarantee that this client will not stop until all the $120.00 worth of paid sessions are recouped. To Optim Health - the Provider has no rights - you can appeal but you know in your guts that they would just uphold a bad decision and judgment call. What hurts most is that the client is active child abuser; though a teacher is an abusive person in personality who will get worse from this private ''victory.'' Besides that because of this bad economy being in Private Practice is even more risky  - especially when Insurance Companies prefer to listen to false allegations against someone despite the evidence and cooperation of the Provider just to get back $40.00!  This is extreme.
   Beware Practitioners - what are your experiences like with HMO's and their answer to false claims against you? Am I the only one that has experienced this??

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      Leta Sposted 15 years agoin reply to this

      I am not talking about physicians and health care providers being framed or maligned specifically--but I well know situations that are basically abuses of the system advocating 'victims' rights' exist.
      
      The 'patient' may be doing this for the money, I'd imagine...or maybe even attention.
      
      Is there any way you can sue this person for false allegations and damage to your professional reputation?  I think you need to weigh the options between being compliant (for your own sake and reputation) and taking the lead in obtaining a suitable outcome before she damages you any more.  This judgment could depend on what you believe/know to be her motive.

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   pioneer_writer5posted 15 years ago

   It sounds like the insurance company wanted to keep their money in their pockets. It is a shame that a reputable psychologist is defrauded when there are so many physicians that are ripping off insurance companies. They order needless tests and prescribe drugs that cause more harm than good. Then you have those who are merely hacks. I hope that you can get past this and continue to give the patience and care that you so obviously provide.

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   Mamie B.posted 15 years ago

   Mr. Shaman, I feel sick to my stomach knowing how deviant and unappreciative a person can be. Especially when he/she is being well taken care of. I'm a retired social worker and counselor. I live in  Canada and hope our healthcare system does not fall into the hands of HMOs. I hear a lot of horror stories from friends in the U.S.
   
   We are not without havoc; our system is not perfect but it helps everyone. Anyway, I'm sending you a hug sprinkled with
   hope, spread to the Horizon of Resolve!
   Mamie B.

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   cabalacusposted 15 years ago

   This does sound horrible.  You said in the original post that the client was an active child abuser so I assume that you have contacted the Police to inform them as confidentiality is irrelevant in this case when children are at risk

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