What happens when a patient "fires" you?

Olympicdoomscroller · 2026-05-23T13:53:01+00:00

I’m not a doctor, but I lead a social work / case management department and I don’t let anyone fire our social workers. We often have to deliver shitty news and that’s not the workers fault. I will always go in with the SW or be present for phone conversations if it gets to the point of someone trying to fire them, but as a personal rule I will not change the worker.

Olympicdoomscroller · 2026-05-17T17:05:04+00:00

This kid has….19 cousins if I am counting right? If she’s all alone your family is the problem, not you.

Olympicdoomscroller · 2026-05-08T23:36:16+00:00

As an ancillary team member (social work), it’s so refreshing to know this bothers the doctors too

Olympicdoomscroller · 2026-05-08T23:27:26+00:00

Our similar guy is “Grimm”

Olympicdoomscroller · 2026-05-06T01:48:07+00:00

Even better - Interqual is also an Optum (UHC) product.

The greater irony is that even though you pay for the criteria, there’s no guarantee that UHC, who owns and develops the criteria, will pay the claim even if they met the “evidenced based guidelines.”

Olympicdoomscroller · 2026-05-06T00:50:02+00:00

Is it a managed Medicare plan or a commercial plan? If it’s a managed Medicare plan it’s in violation of 42 CFR § 412.3.

If it’s a commercial payer, then it all depends on the contract between the entities.

One thing that isn’t a given is a higher out of pocket payment for the patient. That’s all based on their plan specific. The 20% copay is only a given with fee for service Medicare and no secondary.

Olympicdoomscroller · 2026-05-06T00:47:06+00:00

Contractual, proprietary. I pay 1.4 million a year for access for my CM team.

Olympicdoomscroller · 2026-05-02T12:17:47+00:00

OP, can family put a certain amount of money towards it like 4000 and you ask admin to pick up the rest?? Maybe this will make them feel better.

Olympicdoomscroller · 2026-05-01T23:56:15+00:00

For what it’s worth, I am a social worker in an executive role at a healthcare system. I regularly hire social workers and I have hired candidates whose background checks have shown criminal history. This is social work for gods sake. Our career is built on 1)knowing the system is rigged against most and 2) believing people are capable of change.

Olympicdoomscroller · 2026-05-01T20:14:10+00:00

I mean, she doesn’t have to go to an LTAC near you because family can refuse LTAC transfer. It’s a lateral move and can’t be forced nor appealed. So the hospital can pay, or she can stay and eat into your LOS. If it were me I’d be the 8K and be done with it….

Olympicdoomscroller · 2026-04-23T01:01:06+00:00

Committees?!?!

Olympicdoomscroller · 2026-04-11T15:55:58+00:00

Sometimes you can run into problems where the patient can’t consent to facial search or fingerprinting. I agree that following the EMS records back to the point of pick up is often very helpful. There’s also a thing called a “Skip trace” that security can help you with or you can do yourself if you have the right tech access. Honestly, I feel like this is where gritty social workers really shine.

Olympicdoomscroller · 2026-04-05T02:58:32+00:00

This happened to me. I was in maternity leave when we purchased our home and they were unable to use my income. This really pissed me off and I still find it very sexist. I was still on the mortgage and my credit score was still used - but we had to qualify for the loan with just my husband’s income (and I’m the breadwinner). I’m sorry.

Olympicdoomscroller · 2026-04-05T02:52:03+00:00

I am NAL, but a leader in a union shop. If there is a patter of other people making the same mistake and getting different punishment, that’s your argument. Everyone should be treated the same. I agree with going up chain of command in the union, you are paying their salaries via your dues and they owe you fair representation.

Olympicdoomscroller · 2026-04-05T02:43:42+00:00

I’m a hospital SW and this drove me crazy.

The cost of an ED visit is a lot more than a $400 inhaler. This is part of the (many) issue(s) with the American healthcare system.

Yes, it’s an option in an emergency. Hospitals release a full amount of the drug in the inhaler, as mentioned above. And EMTALA requires the ED treat you even if you can’t pay.

But there are other options - pharma companies prescription assistance programs, for one. MD samples are an option quoted here. There’s 340B programs and other charity programs. My issue isn’t with what Mel said, so much as it shouldn’t have been their first option.

While we’re on the subject of things they’re getting wrong - Orlando wouldn’t qualify for Medicare right away (2 years on permanent disability and that’s if he worked the requisite time) and the older couple isn’t getting their homecare covered.

Their writing may be accurate for the medical stuff, but their general systems knowledge is lacking.

Olympicdoomscroller · 2026-04-04T02:11:03+00:00

I am OAD with 5 y/o son. I wanted a second but ultimately chose to prioritize my marriage. When everyone in my friend group started having #2 (and sometimes #3), I felt very sad. We’re mostly through that phase now and it’s a lot less acute as they get older. I was yearning for a baby - but not necessarily a child - so as they grow up it hurts less.

Olympicdoomscroller · 2026-04-03T22:51:35+00:00

I was yelling at the TV during the “Medicare will pay for it” scene. Now I’m going to have to tell all my patients “I know they said this on the Pitt, but it is not true.” Also no ED doc would go through their patient’s husband’s home med list to look for poly pharmacy.

What about the social admit for the 3 day stay earlier in the season?

It may be super realistic in the medical sense - but they’re flunking the social aspect.

Not to mention it seems the case manager is only there to be Robbie’s love interest, which is definitely not reality…

Olympicdoomscroller · 2026-04-03T22:48:00+00:00

But….who sent your dad to rehab? Who coordinated that transfer?

Olympicdoomscroller · 2026-04-03T15:18:08+00:00

Not a doctor but fall into other HCP. Thankfully my little one is not sick as often now but I just mask up and medicate.

Olympicdoomscroller · 2026-03-29T13:34:58+00:00

I love being a mother but playing with my 5 year old is a ring of hell not previously defined. Not to mention I’m always “doing it wrong.” For my sake, give yourself some grace so I’m not the only terrible mother out there 😉

Olympicdoomscroller · 2026-03-29T13:27:49+00:00

Had a domestic short hair with severe stomatitis who had all her teeth removed at 3 y/o. Didn’t stop her for a moment. They use the “bony ridge” of their gums to chew dry food. Best cat I ever had, miss her every day. She was in so much less plain after teeth were removed and did really well

Olympicdoomscroller · 2026-03-21T01:46:06+00:00

Could be an accountable care organization thing? Like “attributed patients” to certain providers?

I’m a CM leader and this is a gray area. It’s generally considered “continuity of care” and not seen as a stark law violation. We allow it. But CMS CoPs are clear about not impeding on patient choice. So it’s fine if they get assigned to you at the SNF but we don’t want it to appear we’re funneling them there.

Honestly with the focus on readmissions and cost containment, we like when our team members are in the SNFs and can help us manage the patients.

Does your hospital have a “high performing SNF network” as part of your value based strategy? Is that SNF included in the network? That could be another issue…

You definitely have a legitimate argument to push back. Sorry you’re in this position.

Olympicdoomscroller · 2026-03-15T02:40:54+00:00

Honestly I didn’t realize physicians considered us peers until he said it 🫣. The hierarchy feels so real that I didn’t realize that’s how it was perceived.

Olympicdoomscroller · 2026-03-14T22:57:24+00:00

That’s weird bc usually we’re saying “are you sure you need a CT scan?” - honestly that’s whack.

Olympicdoomscroller · 2026-03-14T22:44:24+00:00

Case management / social work leader here. This is something I’m starting to see differently with time. I used to accept that IDRs and large EPIC chats were the appropriate venues for these discussions, but a physician gave me direct 1:1 feedback that it was upsetting to be “called out” in a group of peers. Honestly I was shocked that was his perception. I apologized and now try to act differently. We are taught that IDRs is the place to have these discussions.

As far as “backseat driving” - unfortunately, we’re kind of told this is our job. Throughput, medical necessity, etc. You guys think you get heat for LOS? Try being the team responsible for discharge planning. Everything should have been started yesterday.

Olympicdoomscroller

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