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Snark level cranked to 11

I sent out some missives yesterday. I'll redact my doctor's name, the name of office I now go to, and a couple employee's names. But since I am no longer with Unity Health I shall most certainly name them! And yes, I can name who I see now, I just make it a general practice to never do that.

[This one was sent to Unity regarding my medical records not arriving at my new place in a timely fashion. And my left parenthesis is broke, so I use square brackets for them, so no, when you see them it's not me doing a sotto voice to the audience, it was really in the missive. Yes, I mention I'm with Summa, but Summa is fucking huge and has dozens of offices I could possibly be at.]

Subject: Let's learn about patient record requests!

Please forward to any other appropriate entity within Unity. For some reason, not surprising, this was the only email address I could find on the website. I know icky patient contact!

To whomever, probably in the 'call center', that handles patient record requests:

Is there an ICD-10 code of naivety? Or delusions that a medical place will act in an appropriate manner? No? Well there should be, because I actually suffered from both those conditions when I requested my records from Unity, though in the back of my mind I knew it would come to this, because something so simple? Pfft!

My medical records were requested from Unity on April 7th. It is now May 22 and they are not at my new provider’s office, as far as they can tell, though they recall seeing my name on a package last week so maybe? The only thing I received was a bill from Ciox, dated May 10, on May 20 that appears to show my records will be mailed from Georgia [really?!]. That does not count as complying with the rules regarding sending medical records. Actually, this proves you did NOT comply with the 30 day rule. I was told at [new medical office] it was 30 business days; but from a state office, and from reading HIPAA itself, it’s 30 CALENDAR DAYS. Their May 10 dated invoice, which they included with my April 7 dated request, shows that 30 days were exceeded. No calculator needed for that math.So even IF my records arrived last week, that is not within 30 days, it's more than, if you needed help with the math.

I have been having to recreate my medical records with my doctor via memory, past visit summaries I kept, emails I sent friends, and blog entries. I’ve spent at least 6 hours the past couple months doing this. I bill $10/hour, should I counter bill you $60? It’s ridiculous I have no access to my health records and I have had to resort to those measures. But hey, thank Jack Lord I write about my life online, because thanks to y’all it’s the only real ‘medical record’ I have at this point!

I have no doubt that had this request been sent to Dr. [redacted]’s former office, the request would have been dealt with promptly and professionally. Unfortunately, it had to go through the ‘Unity’ office where things are done thru a prism of NEW! STREAMLINED! EFFICIENT! things such as the 'call center', which is a boondoggle for another missive [that one is next!]. I'm trying to convey that outside of the doctor's office things are not done in a patient friendly manner.

Pursuant to HIPAA there is something called Timeliness in Providing Access. “...no later than 30 calendar days from receiving the individual’s request.” My request was sent April 7th and using business days, 30 business days are up. Using calendar days, you’re woefully late and in violation of this. HIPAA also states, since you don’t seem familiar with it: “The 30 calendar days is an outer limit and covered entities are encouraged to respond as soon as possible.” [Underlining theirs, not line, it’s really that important. For some reason medical records can really help physicians care for their patients, you might not be aware of that.]

“If a covered entity is unable to provide access within 30 calendar days -- example, where the information is archived offsite and not readily accessible -- the covered entity may extend the time by no more than an additional 30 days. To extend the time, the covered entity must, within the initial 30 days, inform the individual in writing of the reasons for the delay and the date by which the covered entity will provide access. Only one extension is permitted per access request.” [Emphasis mine.] I received no notice about a delay in the processing of my records. What is your excuse for this lapse in the law? You can try the ‘we didn’t get the request’ line; but alas, I have a confirmation from my provider that it was received the day it was sent.

Regarding the nifty little bill from Ciox, let’s refer to HIPAA again and fees for copies. HIPAA does allow fees for copies, but regarding postage, it is to be charged when the individual requests that the copy be mailed. I did NOT request my records to be mailed. Why in the world would I do that? My medical records are electronic, so why print the pages and mail them? I’m all for annoying Al Gore by printing excessive paper, but in no way shape or form did/do I want my medical records going through the mail. I am a supporter of the post office; but I don’t want the risk of my records being misdelivered, lost, envelope ripped and scattered everywhere, etc. It’s 2017 and you’re MAILING THEM?!

“Further, while the Privacy Rule permits the limited fee described above, covered entities should provide individuals who request access to their information with copies of their PHI free of charge. While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee. Providing individual with access to their health information is a necessary component of delivering and paying for health care. We will continue to monitor whether the fees that are charged to individuals are creating barriers to this access, will take enforcement action where necessary, and will reassess as necessary the provisions in the Privacy Rule that permit these fees to be charged.” [Emphasis mine.] Yeah, the fee creates a barrier of access for me.

“When an individual requests access to her PHI and the covered entity intends to charge the individual the limited fee permitted by the HIPAA Privacy Rule for providing the individual with a copy of her PHI, the covered entity must inform the individual in advance of the approximate fee that may be charged for the copy.” [Their emphasis.] I received no such notice of fees.

“Since the fee a covered entity is permitted to charge will vary based on the form and format and manner of access requested or agreed to by the individual, covered entities must, at the time such details are being negotiated or arranged, inform the individual or any associated fees that may impact the form and format and manner in which the individual requests or agrees to receive copy of her PHI. The failure to provide advance notice is an unreasonable measure that may serve as a barrier to the right of access. Thus, this requirement is necessary for the right of access to operate consistent with the HIPAA Privacy Rule. Further, covered entities should post of their web sites or otherwise make available to individuals an approximate fee schedule for regular types of access requests. “ [Underlining theirs, bolding mine.] Where was this notice at? I know you don’t like to inform patients of things in a timely manner, ie: it took one year to put notices in offices that you were using a 'call center' and who knows if you’ve informed patients yet about how they need to request refills and not pharmacies--because if a pharmacy requests a refill now the request will be ignored.

“Per page fees are not permitted for paper or electronic copies of PHI maintained electronically.” I’m being billed per page and my records are electronic, though it appears y'all were extra special and converted mine to paper. Should I be flattered?

“Flat fee for electronic copies of PHI maintained electronically. A covered entity may charge individuals a flat fee for all requests for electronic copies of PHI maintained electronically, provided the fee does not exceed $6.50, inclusive of all labor, supplies, and any applicable postage.”

Is $6.50 the maximum amount that can be charged to provide individuals with a copy of their PHI? No. … An entity that chooses to calculate actual costs in these circumstances still must --as in other cases--inform the individual in advance of the approximate fee that may be charged for providing the copy requested.”

Is it coming across that, oops, we didn’t do this? Are you familiar with any of this?

I want my records, I didn’t want them mailed, and I’m financially unable to pay the bill. It’s a shame a medical place is unaware of HIPAA medical record request rules. And yes, they very well might have been received last week as paper copies, but it wasn't within the time frame, nor did I request paper records. I am one of those who cares about the principal of the matter. I am reporting the time violation to the appropriate agencies and perhaps they can impress upon you the importance of patient's access to their records. I have no doubt I am not the only one this has been done to by you.

Maybe it's just something Unity/Western Reserve does when someone transfers to Summa? Isn't that lawsuit still going on? I can see such pettiness, I mean the U.Y.S. [Up Yours Summa] acronym and then using patients as pawns. Yeah, I could see that. I can actually respect pettiness and passive aggressiveness, but NOT when it involves the health and welfare of people.

Miss Tia


Now here's the email I sent to the place that sent me a bill for my records. The company name is Ciox.

Subject: Invoice 0216324626

Hi! I got an invoice from you for my medical records. I've no doubt you're unaware of this; but my former provider, Premier Medical Partners [AKA Unity] violated HIPAA's rules regarding record requests. I was not informed of a price beforehand, they violated the time limit, and furthermore, I am financially unable to pay for my records. I do need to thank you for this bill though, as it proves without a doubt that Premier Medical violated the timeline requirement per HIPAA rules, so sincerely thanks for this evidence.

Aside from that one positive, I did NOT agree for my records to be mailed. So even if I was financially able to pay for my records, the method of transference was not one I would have selected. Electronic records are to have a $6.50 fee maximum, except in certain instances, and again, with that, one is to be notified beforehand of price. When you receive electronic records there is no 'per page' fee. I'm all for wasting resources, because every time you do Al Gore feels a pinch; but I would not want my records printed out and mailed as that is not secure.

I'm unsure what in the world a company in Georgia is doing with my medical records; but I don't like that. No sir, I don't like that one iota. I'm not phoning the number on the invoice, as I have to spend more time trying to recreate my medical records from memory, past visit summaries I had kept, emails, and blog entries. Do I send you a counter-invoice for that? Or Premier Medical Partners?

Do not contact me via phone. In addition, I will not pay this bill, even if I was financially able, as I was not made aware of charges beforehand. As far as I am concerned your company name has a superfluous 'i' in it.

Understanding why there's a class action suit against you,
Miss Tia


My other missive to Unity summing up my issues with them.

Subject: Sticks, Carrots, Fertilize My Garden Unity!

Please forward to any other appropriate entity within Unity. For some reason, not surprising, this was the only email address I could find on the website. I know icky patient contact!

To whomever, probably in the 'call center', that handles complaints/concerns, because yes, even though I will no longer go to Unity, I do have concern for others. I probably should see someone about that, as concern for others is the first sign of liberalism. GASP!! Wait, maybe I just heard that on Fox News? Yeah, that's vegetable fertilizer there. Regardless, I do have genuine concern for others.

Knowing this is an exercise in futility, I still put forth the effort to send this. I know patients are really about the last thing Unity Health considers, but perhaps some day you'll have to realize that patients should be your first priority. An important way to convey they are your priority is to communicate with them about changes, things you do, etc. In my time there Unity Health failed miserably at that. Why communicate to the patients? I mean, you know best, so patients should just shut up and accept whatever right? Even old school doctors were communicable with their patients, why the detachment now? We're still human beings. Here are 5 areas Unity Health really fails in. Then yes, I will give you a carrot after the sticks.

Call Center: Considered some 'crowning achievement', this is truly a boondoggle of a debacle. You describe what is wrong with you, why you want to be seen, then get to the doctor's office and it's either something you didn't say, or it just says 'sick'. On rare occasions it was accurate. Rare as the Cubs winning the World Series. GO CUBS!!

Sometimes you'd get someone who would say hello, how are you, first; but usually it was just a barking order for your birth date. I never felt comfortable with that 'call center' and they might have well been in India as far as I was concerned. It took Unity almost 1 whole year before notices went up in offices that calls were going to a call center instead of directly to the doctor's office. Why not tell people right away? When you get off-putting people and not realize it's a 'call center', you think the staff at your doctor's office has changed and been replaced with a bunch of soulless uncaring automatons. That was genuinely concerning until you arrived there and WHEW! The caring individuals you've come to know over the years were still there. So the soulless uncaring automatons are just at the 'call center' for now. May they some day escape into freedom and humanity!!

RX requests: I wonder if patients have been informed about the new nifty Unity rule where patients are to call in their own prescription refill requests to the 'call center'? I'm gonna gander a guess that no, no they have not, because it hasn't been a year. I learned of this the hard way, when Klein's repeatedly left messages at the 'call center' and no refill came through. I had an upcoming appointment and no, my doctor's office hadn't received a refill request, because had they, it would have been handled promptly. Got it written at the doctor's office, then contacted Unity and learned of this nifty new 'rule'. I was told that if a pharmacy calls for a refill, the 'call center' was to call the patient and ask if it should be filled. I received no calls. It was then claimed in the Unity phone logs there were no calls from Klein's requesting my refill but Klein's had records of the times they had called. I trust Klein's over Unity on this, especially when that 'call center' is involved. Had the calls gone directly to my doctor's office, I KNOW the refill request would have been handled promptly. But no, why let that happen? Make pharmacies call the 'call center', then have the 'call center' call the patient---if the 'call center' acknowledges they even received the request---to see if they wanted the refill. Make more work and waste productive time!

It happened more than once to me but I never bothered to contact Unity about the other times because I knew I couldn't stay at Unity much longer with how it was being run. Not to mention I already knew what the retort would be 'we didn't get the request', which would be a great answer to help fertilize my vegetable garden. How many times do you use that denial line? De'Nile is a river in Egypt, let's keep it that way.

Floatees: Individuals are hired as floatees that lack medical skills for their position. I had a floatee who are unable to properly take my blood pressure. How is this even possible? I honestly thought I had an adult 'make a wish' person who wanted to be a medical tech for a day. I had to put the BP cuff on myself, and even then they then couldn't take it properly. I could have done so for them, but that's not my job [and an aside, I don't have medical skill training, I played a nurse a lot in college though]. They were also unable to properly take my heart rate. Then they wanted to go over my medical history, including medications. They couldn't even pronounce 'valium' correctly, which I sure needed at that moment. I know some meds are hard to pronounce but valium? ulltram? naproxen? Apparently they had been there all week, just for one week, and it had been like that the whole time. So no one screens employees? No one ensures they can take a patient's BP if that's part of their job? For some patients their BP and heart rate is important to have accurately taken, if you weren't aware of that.

A few weeks later, I got another floatee, who thankfully could take BP but again wanted to go over my medical history. I refused saying it was done a few weeks prior. They said Unity wanted it done every visit. Now I dunno if that was true or not; but if it was true, what a waste of productive time!!

Drug testing: I know darn well this wasn't determined by my doctor's specific office and had to have come from Unity's office. When people who are prescribed controlled substances by physicians are given urine tests you should NOT LIE TO THEM, nor hold them 'hostage'. I think the lying is worst. You're held 'hostage' because you're told if you don't pee on command your prescription will be withheld for 6 months. The last time this happened to me, I was held 'hostage' for almost an hour and a half and drank so much water I was about ready to throw up. I was told, as I had been previous times, that this was a law by the Pharmacy Board. Since I was being held 'hostage' for so long and was feeling so sick from all the water, I fired off a missive to the Pharmacy Board. They replied the next day stating that they did NOT have such a law nor rule and gave me the number to the state medical board, suggesting that they might.

I called the medical board and was transferred to a nice lady there with whom I had to pull the phone away from my ear when she loudly exclaimed "THEY CAN'T DO THAT" when I explained the withholding of a RX for 6 months. But but the pharmacy board law. She picked up I was sarcastic very quickly, which is nice when people do. The lady told me there was NO LAW requiring urine testing for the prescribing of controlled substance BUT there is an Ohio Administrative Code [yes I have it, but you can find it yourself, do something productive, thanks] that states it is at the physicians' discretion and she explained why so many physicians did that. When she explained why to me, it made total sense. No, I shan't share that with you, as you might use it and I'll be damned I help you out. She also said urine tests should be done at office visits if possible, which makes sense, and prior to the last time I was held hostage I had actually peed in a cup and could have filled several. I guess that made too much sense? I told her it was always done when you came in to pick up the RX and then you were trapped, held hostage, or they'd refuse your RX for 6 months claiming it was the law.

Why do you lie to patients about this and subject them unneedlessly to this?? Lying to a patient is a breach of trust if you weren't aware of that. Inconveniencing patients and making them sick from drinking so much water isn't good for them either. Explain why you do it at the doctor's discretion and patients would understand that. Believe it or not, most patients are more than capable of understanding such things and I'll even go so far to say that most patients would appreciate being treated with respect. Lying is disrespectful. Do the test at a random office visit, what's wrong with that? I understand you can't tell them in advance, but if someone is in a lot, um?? I guess that just makes too much sense and it's more sadistically fun to lie to patients and hold them 'hostage' or deny them their medication? The lady at the medical board was just aghast about the possible denial of medication because she said some controlled substance withdrawals could cause serious medical harm. But...but...the pharmacy board! Gosh, more stuff to fertilize my vegetable garden with.

Records requests: You have 30 days to fulfill a request. 30 calendar days. If you're going to charge for copies you need to tell the person in advance. Did I mention 30 calendar days? You have 30 calendar days. It really sucks having to try to recreate your own records. I feel I should bill you for my time for that, as it was a waste of productive time. Oh wait, that's MY productive time, so yeah, the hell with that. One truly appreciates access to their medical records though when they no longer have them. And that was a separate missive where I hopefully helped you learn about record requests.

Carrot: Dr. [redacted]'s staff has always been fantastic. Very professional, yet also friendly and caring. Special shout outs for [redacted] and [redacted] there. The man who did blood work across the hall always did a fantastic job. I know Unity is linked with Western Reserve and the Western Reserve Physical Therapy at the Nat is a place I would, and will, recommend to anyone who needs physical therapy.

Unfortunately I can't recommend Unity Health. Despite how much I liked Dr. [redacted] I was ready to leave due to how the patients were considered an after thought by Unity's 'main office', not the individual doctor's offices, as I believe I can safely assume many are like Dr. [redacted] and truly care about their patients. When an entity has a failure to communicate to patients about how their appointments are made and how much access those people have to their records; ignoring RX requests--right right, never got it, uh huh, let me scoop that on my vegetable garden; refusing to state the truth of testing for patients on controlled substances and preferring to lie; hiring people who don't have basic medical skills to work with patients; and violating rules about record requests, well it makes a relationship untenable.

Maybe some day you'll realize patients should be treated with respect, honesty, and not be petty when they leave the practice with their medical record request. That's an assumption on my part. I believe it's a safe one.

You've really fertilized my vegetable garden well, so hey, thanks for that,
Miss Tia


I keep getting notices from Summa Breast center to schedule another mammogram. I sent them this.

This is for the Breast Imaging Center:

Could you please remove me from your mailing list? Also, I find your notices to be purposely misleading and worded in a manner to alarm people. Saying "Our records indicate that based on your tomosynthesis screening mamogram..." it's time to schedule another. Think about that wording. Why not say, It's almost been a year since your last one, please schedule this year's? When you say "based on" that could/would make someone automatically think something was wrong. It did me! Though I knew the results was fine.

Anyway, I will NEVER EVER have another mammogram again. Oh hell no!!! The first one I had at Akron General was absolutely painless and I had no idea why people said they were so painful. Ah, I went to Summa last year, now I know. The lady said that Akron General did them the same way, when I said my last one was painless, but I cannot imagine Akron General turning to barbarism. Why do that?

There's no way in hell I would ever do that test again. Unless you decide to stop being barbaric torturers. Yes, I'm aware of breast cancer risks and have had biological relatives die from it. Hey, we all gotta die of something. I think getting a mastectomy without anesthesia would be less painful than that mammogram I had last year. My boobs are pretty non-existent anyway, I don't care. No, I won't go to Akron General to get one either, since according to your employee last year they've become barbaric too. Why do that?

Also, you don't even mention the day before about no deodorant and there was a sign in the locker about it but it was fully covered up. I remembered it from my first one; but no one said anything. The tech didn't even ask me. Just basically strip it off, let's torture you, hey let's torture you more, more, and PLEASE come back in a year so we can do it again! Hell no!

May your boobs or testes be smashed flat in a panini maker, repeatedly,
Miss Tia


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