Frustrating!

[AngelfireRN, MSN, RN, APRN]

I swear, I think, now that I have turned in my notice, these people are going to find every way in the world to dump on me and make my life a living heck. I don't mind it so much for me, because it's no more than I expected, but when my patients suffer for it, then it makes me really mad.

I have been seeing this gentleman for the entire time I have been at the clinic, and since August, he's had a 'spot'. He has a hx of skin CA, and this looks for all the world like a squamous cell CA. In August, he said that he had a cousin that worked for a derm, and he would get an appointment. He has an insurance that most derms will not accept. I agreed to let him, and asked for the reports, when he went.

2 months, he comes back, no treatment. They're trying to get him in. OK, so be it. He refuses referral. I document.

This week, he's back again, the 'spot' is now the size of a quarter, and looks like absolute Ned. He tells me that his cousin could not get him an appointment and that he has called 'everywhere' and no one will see him. I mention the most popular derm practice in the area, and he says he called, but they would not see him.

As this is getting serious, and as I'm not sure he's not just feeding me a line (yes, I know derms are expensive, but losing your nose isn't a picnic), I ask him to wait, and go call the practice myself. I'm at my desk, so OM hears me. I get the necessary info, yes, they will see him, but he will have to be a self pay. These are the prices for visits, biopsies, etc. This is the number he should call, who to ask for, and the info to have available. Great! Right? Wrong.

OM and the referral gal refuse to refer him. Why? Derms don't take Medicaid. I already knew that. He's OK with being a self-pay. They still refuse. Why?

"If they find out he paid cash, he might lose his Medicaid." And? This man has a skin CA that NEEDS TREATMENT! If Medicaid won't cover it, and they cut him off for paying OOP for the treatment to save his face, well, he's willing to chance it. No dice, they refuse. OM even told me not to give him the numbers, since "he could lose his insurance". Said the derm practice in a bigger city over 2 hours away 'might' see him and accept his insurance, but they refused to set it up. "He won't want to drive all that way."

Well I did, and he promised to call the practice himself. I documented that I gave him the info. I did try to set up a referral myself, just basic info, while I was on the phone, as the patient said that was fine, but the practice wanted him to call himself.

I know they're mad. I get that. This week has been pure perdition. But how can they justify sitting on their ever-widening bums (yep, I'm being snarky) and refusing to help me help someone in the state this guy was in? I'm thinking I may just need to cut my losses, cut my notice, and get out before they really try to throw me under the bus.

Any thoughts?

[moonchild20002000]

How much longer are you there? Just continue to do your job and try and ignore staff.

[AngelfireRN, MSN, RN, APRN]

Two weeks, maybe a day or two longer, depending on when my licensure goes through for the next job. I do try and ignore...it just cheeses me off when my patients suffer because they want to keep that insurance money coming in.

[May2013]

Wow! Talk about unethical practice! So sad!

[TX RN]

Umm.... I would totally go over their heads. Patients come first. Rules....., yeah, they're in place to keep "fraudaluent or illegal" activities from occuring. I would absolutely challenge "rules" when it comes to patient wellbeing.

[ivanh3]

I would be super careful about posting some of this information. It seems perilously close to violating privacy. Just sayin'

[AngelfireRN, MSN, RN, APRN]

Thanks, Ivan...it's all good.

[j3j2jones]

Have you tried referring him to plastics?

[AngelfireRN, MSN, RN, APRN]

This patient, to clarify, knew I was going to seek advice. They're OK with it.

[AngelfireRN, MSN, RN, APRN]

Yes, no go on that. Insurance issues, and the cost was exorbitant.

[TX RN]

There's no mention of a name, so I really don't see where there's a privacy issue.

Or did I miss something?

[AngelfireRN, MSN, RN, APRN]

You didn't miss anything. I am deliberately vague, for a reason.