11/14/2011
Glen L. Goslaw
Scan Health Plan
ATTN:Grievance and Appeals Department 3800 Kilroy Way, Suite 100- P.O. Box 22644 Long Beach, CA 90801
Re: Notice of Denial of Medical Coverage
This is my written appeal for a 72 hour review of your denial of medical services, dated 11/08/2011 and received by mail on 11/12/2011. The basic reason for the appeal against this denial is that you contract for services with Heritage Victor Valley Medical Group, who has provided lousy care for this Scan member over the last eleven months. I could recount the long history of medical boners but let me attempt to stay on point. There seems to be no competent or appropriate vascular surgeon affiliated with this medical group and they and you have spit at the medical welfare of this patient.
Vascular surgeon # 1….. Dr. Suval of Victorville.
Dr. Suval informed me that he did not treat ascending aortic aneurisms, only the lower vascular system. He did a lower vascular CAT scan and found no abnormalities. Dr. Suval is either a liar or Heritage sent this patient to a doctor who could not treat an ascending aortic aneurism. This was an erroneous referral and should not count against the plans maximum of two referrals to an appropriate specialist.
Vascular surgeon # 2….. Dr. Alturjuman of Riverside.
Dr. Alturjuman admitted me to Riverside Community hospital the second week April, 2011, with horrendous chest pain. This was the third such occurrence since January 4 of 2011, he did another complete heart workup with multiple CAT scans and a stress test, repeating the tests of January at St. Mary’s in Apple Valley. The pain went away after about 12 hours and Dr. Alturjuman insinuated the pain wasn’t real and discharged me in one day, on a Sunday night. Monday morning I drove myself back down to Riverside and got my medical records for the stay just completed. The report from the CAT scan described my heart as “grossly enlarged”. I marched up to his office and asked pointedly, how can this be when you discharged me without a word? His only response was, “you can make another appointment”. Lame, baby, lame.
The pain returned within a week and I was rushed by ambulance to St. Mary’s in Apple Valley. With this fourth occurrence in four months, they removed 200ml of fluid from the heart sack but the fluid returned in 12 hours. With no other alternative, they sent me by ambulance to Dr. McPherson at Saint Vincent Medical Center in LA. The services at this hospital were excellent, as was the surgery to drain my heart with a “pericardial window”. Since this surgery on April 23, 2011, I have experienced no pain. Even this dummy has figured out that the “grossly enlarged heart” was fluid not a “grossly enlarged heart”. Dr. Alturjaman has caused this Scan member anxiety with his incompetent care and I will not return for more of the same.
Let’s get back to the ascending aortic aneurysm. The CAT scan in January 2011 alerted the doctors to the aneurysm. I was told by Heritage Medical group doctors that in all three Cat Scans the aneurysm measured 4.5 cm. The last was in April 2011 and again I was informed that it was 4.5 cm and stable. Not so, for at a routine appointment on November 8, 2011, my new primary care physician informed me that the written report for the April CAT scan measured the aneurysm at up to 4.9 cm. The game being played by Heritage and Scan is to risk a negative outcome to this member in order to hopefully save a few dollars. Scan and Heritage, how long are you willing to wait when my life is at risk? Possibly your plan was for me to drop dead or change insurance companies by December 7. Motive enough, I guess , for you to keep quiet about the unstable aneurysm. Thankfully, my new honest primary physician was alert to your game. I am now insisting on an appointment with a cardiovascular surgeon, other than the two aforementioned doctors.
The final injustice resulting in this diatribe is that Heritage Medical Group and Scan have failed to pay Dr. McPherson for the surgery in April. The $9000 bill has been repeatedly sent to me, and Scan. The account is now in collections with my name on it. All the TV and newspaper advertising of your organizations cannot mitigate your dismal history with this member. I shall remain locked into your system until you pay that surgery bill! After that I will make an exit asap to anywhere besides Scan and Heritage Victor Valley Medical Group.
Please send this Scan member to another vascular surgeon, preferably Dr. McPherson at LA Cardiovascular, and do it now.
G.Goslaw Victorville, CA
