EPISODE NINE: A Review of Sendero Health Plans, the Insurance Company that Keeps Patients Sick with Worry
Days 68–74 of Illness
We spent a couple days in phone tag; Sendero has only two GIs on their plan, and one was at a Comm Unity Care clinic, which I was not comfortable with. The other, Dr. Reddy, did not have an appointment until May 20 when I called them. This was over a month away, and I knew I could not make it that far. I called back to Dr. Edoka’s office. Michael the assistant said he’d see what he could do. A few hours later, he called to tell me that Dr. Edoka had spoken to Dr. Reddy and that I could get a sooner appointment now, and that Dr. Reddy’s office would call me before the day was over.
His office never called me. The pain had reached its absolute worst point, spasms of extreme pain causing me to double over. All I could do was cry hysterically. X took me back to St. David’s South Austin ER. This time, the ER gave me morphine and prescribed me a short supply of Tylenol #3 (tylenol with codeine). They were kind and sympathetic, and did everything they could. They couldn’t do much, since I had so many tests done recently. They discharged me that night.
I called Dr. Reddy’s office the next morning. Still not appointment before May 20.
I called Dr. Edoka’s office again about the appointment. Michael the assistant sounded surprised that I still couldn’t get an appointment. He said he’d see what he could do.
I called HAAM asking for help seeing the GI sooner, and they called Sendero to advocate for me. They said that Sendero would assign me a Case Manager and would call me shortly.
A Customer Representative from Sendero called me to ask preliminary questions to set me up with a Case Manager. She said that I could have asked for this at any time, and scolded me for not asking sooner. I nearly lost my temper, but instead said that I wished ANYONE at Sendero had let me know this was an option at any of the times I had called or written, begging for help. I was so angry but also hopeful that a Case Manager could help me.
Sendero withheld information from me, hurting my health and damaging my chances for faster treatment.
My Case Manager, Elizabeth Guidry, called me a short time later. She was kind and listened to my entire story. She said she’d help me see Dr. Reddy sooner. She called me an hour later, said she spoke with Dr. Reddy’s office and they agreed to schedule me as a “write in” in one week. This meant that I would arrive at 3:30, fill out paperwork, and be the last patient of the day, squeezed into whatever time remained.
The week was ok because I had drugs to numb the pain. It was nice. I expected and hoped that Dr. Reddy could refill them when I saw him, because at least this way I was able to eat and sleep. The pain had been preventing both, and my health had been in decline.
