Memos Of The Week

by Mark Scaramella, May 4, 2011

February 4, 2010

To: Patricia Beverly, Boonville California

Dear Patricia Beverly:

Welcome to the Blue Shield of California or Blue Shield of California Life & Health Insurance Company COPD program! We are offering this program to you at no added cost, as part of our continuing effort to help you manage your health. The program is completely confidential and privacy guidelines are strictly followed.

To start, we've enclose some educational materials and self management tools. These will help you learn more about COPD and ways to manage your condition. You will also have access to the Blue Shield Care Center, a confidential, personalized and interactive website with tools and information designed to help you manage your condition. Register and log on today at carecenter.alere.com.

Please note that the COPD program provides educational and support services that are intended to complement, not replace, the care provided by your physician. Your physician will continue to treat your condition, and we encourage you to talk to him/her about your enrollment in this program. If you have any concerns about your health, you should contact your physician, or in an emergency call 911.

We hope you will find this program useful. If you have any questions about the program or the materials enclosed, please call us toll-free at 866-954-4567, Monday to Friday, from 6am to 6pm, and Saturday from 7am to 5pm. If you are hearing impaired, please call 711 for the relay service in California.

Sincerely,

Andrew Halpert, MD, Senior Medical Director

Blue Shield of California, San Francisco

March 11, 2011

Dear Patricia Beverly:

According to our records, you have been enrolled in the osteoarthritis program offered by Blue Shield of California or Blue Shield of California Life & Health Insurance Company.

Because you are no longer eligible for participation, your enrollment in the program will end. If you have any questions, feel free to call us toll-free at 866-954-4567 Monday to Friday from 8am to 8pm PST, and Saturday and Sunday from 8am to 5pm PST. If you are hearing impaired please call 711 for relay services in California.

We hope the education we provided will continue to help you. We encourage you to:

Talk to your doctor about any symptoms associated with your osteoarthritis.

Take your medications as prescribed.

See your position on a regular basis.

Please note that the osteoarthritis program has provided educational and support services that were not intended to replace the care provided by your physician. If you have any concerns about your health, you should contact your physician or, in an emergency, call 911.

Thank you for participating in the osteoarthritis program. We wish you the best of health in the future.

Sincerely,

Andrew Halpert, MD, senior medical director,

Blue Shield of California, San Francisco

March 18, 2011

To: Andrew Halpert, MD, senior medical director, external clinical programs, P.O. Box 7168, San Francisco 94120-7168

Dear Dr. Halpert:

When I receive your letter of February 4, 2010, welcoming me to Blue Shield of California's COPD program, “as part of our continuing effort to help you manage your health,” I studied the “enclosed educational materials and self-management tools” carefully. Assuming that the letter was my primary care physician's follow up on a recent office visit regarding chest wall pain, I followed the guide for green zone level symptoms and finally quit smoking in January, 2011.

Imagine my surprise upon receiving your letter of March 1, 2011 (an exact duplicate of your February 4, 2010 letter), including materials, noting that my physician would “continue to treat your condition,” and advising me to study materials enclosed. I discovered that, despite continued exercise, not smoking, and generally good health, I was now at Level 2 suffering especially from depression and excessive worrying and difficulty sleeping. Assuring me that these are common symptoms of COPD, the materials advised me to get my inhaler ready, arrange for oxygen tanks and advise my family to prepare for the burden my inevitably declining health would place on them. Having watched my mother-in-law died of emphysema, I got the message.

I contacted client manager Adriana Romero at 866-954-4567 to ask about my apparent decline. Having seen Dr. Apfel on March 8, 2011, when he assured me that I had never been diagnosed with COPD, but was clearly depressed and needed treatment for that, I asked Ms. Romero how I had been placed in the COPD program. She was courteous, efficient and apologetic regarding concerns over an implied diagnosis.

This letter, then, is addressed to you with these questions:

Why am I on this program?

Why no notification to my MD, Dr. Apfel?

Why no disclaimer in your introduction that this is a computer-generated diagnosis?

Does the above-mentioned computer not have access to services paid for by Blue Shield during September 24, 2009 emergency treatment for status mal seizure (including ambulance, x-ray to ensure no aspirated materials, and emergency treatment with room, bed and two physicians attending)?

Please provide the name and address of your supervisor.

I have enclosed a self-addressed stamped envelope for your reply. Please respond to Adriana Romero and her manager with information as well, since she too is concerned with effects of implied diagnoses.

Sincerely,

Patricia Beverly

Boonville

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