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Presbyterian Health Plan (PCSC) in ABQ, NM uses retalliation tactics against their employees

ICE

by: Frankie Met (former employee)

I honestly had little hope for the position in the first place, but to be fair, they were initially able to look past how awkward a fit I was for the company.

What little clerical/medical industry experience I did have was confined to a 9 month stint as a receptionist/medtech for an urgent care center in Greensburg, Ky, and a dizzying array of different phone sales jobs, the longest being 1.5 years working for Orbitz travel website.

During our first week of training, we were all asked to give some detail about ourselves, including work history we thought would be applicable to the Member Services positions we’d been hired for; it was not the first choice for me, considering that the food service industry typically has less of a formal environment where a sense of humor like mine can flourish. That’s not to say I’m a bigot/sexist, as the job I had before my short time with Presbyterian Health Plan ended with me being shorted 3-5 hours on my check and a standoff with the owner of the restaurant as he tried to escort me out the door when I inquired about the reasoning.

So it was a nice change of pace to find a job where a Human Resources policy/department was already in place, and the details of proper work etiquette were neatly laid out in the training manual at my desk.

Although it was a long 5-6 weeks, our actual training was cut short as the call volume had increased exponentially due to the most recent changes to the ACA (Affordable Care Act) and the open enrollment period for 2015 coverage. Learning about the benefits of a high deductible plan (Typically your premiums are low for this type of coverage, but the deductible is so high that you pay an unreasonably large amount for medical expenses until that deductible is met for the year. New year, new deductible.) vs. an individual HMO (Health Maintenance Organization) which essentially limits the choices of providers you can see to an in-network (mostly in-state doctors,) level, I became suspect of President Obama’s claims that:

This law will cut costs and make coverage more affordable for families and small businesses. It’s reform that brings — that begins to bring down our government’s long-term structural deficit. It’s reform that finally extends the opportunity to purchase coverage to the millions who currently don’t have it — and includes tough new consumer protections to guarantee greater stability, security and control for the millions who do have health insurance.”

A decent majority of members I spoke with said that they were having to make hard decisions that are all too common stories in the American Media.

“I have to choose between filling my RX for Aptiom, and paying this fucking premium!”

“Sir, I’d be more than happy to help you, but I can’t have you cursing on the line okay?”

“You’d be pissed the fuck off too if you had to worry about seizures all the fucking time…”

“Okay sir, I’m sorry, but I’m going to have to disconnect this call. Thank you for calling Presbyterian. Here’s a brief survey.”

“Obamacare is bullshit! There’s all the answers you-“

As a CSR, if you were fortunate enough to pull an “escalation call”, procedure dictates that you are to send this up to the TL (team lead) line, where another more experienced representative will take over the call and try to deescalate the member. The running joke is that this is part of procedure in the first place, considering that you’re better off looking for the information yourself, even without the benefit of full training, as opposed to spending 20-30 minutes on hold, just for someone to come on the line and chastise you for not doing the research. Not every TL is like this, but there are enough employees that work at PCSC (Presbyterian Customer Service Center) and answer these lines with either an accusatory or completely disinterested and particularly annoyed tone. I myself was given incorrect information numerous times, once involving a woman whose RX copays had been overpaid for a series of 6-8 months. When I called the TL line, I was instructed that even though the woman had overpaid for the RX’s, since it was a pharmacy issue, I would need to submit an SR Request (basically a reconfiguration of the member’s copays on the benefit grid in our system,) and that the process would take somewhere around 30-45 business days before the woman could go back to the pharmacy and be reimbursed.

“I live on a budget! I’ve been dealing with this for months now and you people always say you’re going to help me but you don’t! The pharmacy is telling me that if I don’t get this resolved by March 3rd, I won’t be able to get my money back!”

When you turn a call over to escalations they keep a record of your name and how many times you are forced to rely on the service. With the previous training I had trying to pull credit card #’s from senior citizens and construction workers, talking an angry member down was fairly easy in most scenarios. But every time I heard the word “escalation” I cringed and scattered to resolve the situation promptly, knowing that my name should not be on any lists if I could avoid it.

My supervisor was always commending me on my performance. My first month on the floor I received 3 100% call audits and a customer kudos call. I took to the job like a duck on water in a scuba diving suit. I consistently took one of the highest volumes of calls on my team, was never late, and it was a good 3 months before I missed my first day of work. My co-workers were very friendly, there were always potlucks, and the diversity of the workforce made me feel at relative ease, considering past employment experiences being somewhat skewed in terms of the represented demographic. Sure they were pretty strict about certain things (no hoodies inside the building, no visible tattoos, no smoking unless in designated smoking areas, etc.) But I was certainly inclined to overlook any lack of stringency on such matters, as it is custom for a company to set expectations and the employees to follow them.

And with this attitude, I approached every day with a revitalized trust in the American workforce. I finally found a niche for my skillset, something that made me feel genuinely proud of the days’ toils, and left me with the knowledge that I helped people navigate through all the red tape of the modern medical industry. Provisions were clearly laid out in the Summary of Plan Descriptions, but as we are so apt to do in this country, many people simply overlooked the fine print/superscripts in the details.

While employed there, I noticed that the lack of empathy I had for general society, had slowly begun to subside. My sleep schedule changed drastically and for the better. I was working out more, gaining weight (which is really really hard for someone with my kind of metabolism,) and interactions between myself and my wife grew more pleasant by the hour. She would make observations like:

“I’ve never seen you so happy. Usually you’re just pissed off for the first 3-5 hours you’re home. I’m so proud of you!”

That meant the world to me, my wife being proud of what I was accomplishing, because never have I met someone so utterly talented and intelligent as her. It gave me even more reason to wake up with an empty stomach, make the trek to the bus stop in the snow, and even enjoy the 9 mile, hour long bus ride I had to take to get to work every morning.

But in the back of my mind, I couldn’t shake this feeling of impending shock, and at the time, I simply attributed this to all the years I had spent working shit jobs and barely making it by before the door shut on me for good. I was (am) dealing with periodontitis and a daunting $3,000 dental bill, and more than a little worried this job would end before I could get the scratch together to fix my teeth.

But the end didn’t come as early as expected, and for several months I cruised through everyday workloads without any trouble.

One day, I was walking through the parking with an unlit cigarette in my mouth, when I was accosted by a security guard at the facility. He was on his cellphone the entirety of the exchange, screaming at me to get on the sidewalk with the cigarette. Perhaps he didn’t hear me, as he was deep in conversation with whoever on the other line, but when I advised him that the cigarette wasn’t lit and I was making my way to the smoking section, the situation escalated to the point that he demanded to see my badge and chased me onto the sidewalk with his hand on his hip (Whether he had pepper spray or a gun, I’m not sure, but either way, I felt very intimidated and thoroughly embarrassed.)

When I brought this to the attention of my supervisor, he advised me to contact the security office and file a report, but being a guy that doesn’t like to make waves if he can avoid it, I chose to ignore the situation and stay as close to the smoking section as possible during my breaks.

Two more months passed without incident…

Aside from a few instances where I let my mouth/frustration get the best of me, I was a model employee. I maintained the precedent I had set for my stats. I maintained a good attendance record, and grew even closer with my teammates.

It was a weekend in March when my wife went to the UNM Urgent Care facility for a migraine that had been bothering her for a few days. She was examined in triage, and rushed to the ER, showing symptoms of spinal meningitis. Before the incident, the most time I had stayed at home was after finding a bed bug crawling up my shirt at work. The company gave me 3 days off without repercussion/with pay, and even sent Truly Nolen Pest Control to my apartment to check for any infestations (None were found thank God.) Apparently a co-worker had previously brought in the early makings of a colony and the issue wasn’t noticed until a routine pest inspection came by her cubicle and saw the bugs crawling all over her chair. Presbyterian tried their best to keep publicity about the issue contained, and to this day, I’m not sure if the citizens of Albuquerque know that the main hospital downtown also had the same problem at the time.

My wife spent 5 days in the hospital before being assured that since she had contracted the viral strain, in place of the bacterial strain, that further hospitalization would not be necessary. Thankfully she has Centennial Care (Medicaid) or otherwise we’d be looking at a hefty medical bill for her stay. I myself am still uninsured and working for an insurance company, I felt more than a little paranoid that the Obama administration was just lying in wait to fine me for it. When I came back to work, I was not advised that my attendance was an issue, and being a temporary employee, I was even asked if I wanted to apply for a permanent position. I had already tried once before, but the STAR (Situation Task Action Result) formatting of the questions threw me off and I didn’t get the job. This time, I advised my supervisor that considering my wife’s medical problems and my own dental dilemma, the fact that taking a permanent position may impede on time off requests (Once you go permanent, there is only PTO. No vacation days, w/o it. Otherwise you get an occurrence.) I was assured that he understood and I didn’t hear any more about it, save for the occasional mass email informing us that there were permanent listings on the website.

As I said, some more time passed without any more occurrences with security.

My hair had grown longer since the last run-in, and had become a strange fixation for some of my co-workers. I had just been assigned to Provider Care Unit training, which was a step up for me, and meant that I would be primarily dealing with Drs./NP’s/Billing Office Reps directly as opposed to members. I was very excited about the new job, and on the morning in question I walked the 2 mile sidewalk in front of the building with an overwhelming sense of confidence that this was an actual career, something I thought would only happen for me had I finished college when I had the chance. I was wearing a black hoodie (Near the mountains where my office was located, it was still very cold outside at 7:30am,) and sunglasses. My hair stuck out from the hood at the top, because of its sheer volume. I was wearing crisp Old Navy tan Dockers, a Calvin Klein long-sleeved button-up, and brown Nautical slip-on loafers. I was in full compliance with Presbyterian’s stipulations about business casual attire. I walked to my usual spot in the smoking section, and per policy, kept my work badge covered while I smoked and watched the sun rise over the mountains. I had my headphones on at the time, so when the security guard walked up to me with his inquisitive glare, I naturally ignored him for the first few seconds. Until I saw his mouth moving.

 

“What?”

“Do YOU WORK HERE?”

“Yeah.”

“Let me see your badge.”

I unzipped my hoodie and held it out for him to inspect, inspect again, inspect one more time and make snide faces at what I can only perceive was the badge’s validity.

“Okay?”

“Okay.”

“Why did you ask to see my badge?”

“I got a call about a suspicious character fitting your description. Just following up. It’s procedure.”

“Well, I work here.”

“…Yea, I can see that.”

He walked away chuckling to himself, over what I wasn’t sure.

Hours after the fact, I found it hard to concentrate on my work. Being used to racial profiling (I’m from Kentucky. It’s a regular thing there,) I couldn’t shake the impression that what had just occurred, what happened months prior, had something to do with my “appearance”. There were plenty of white/Hispanic/Native American men & women that wore hoodies outside of the building, and as far as I knew, none of them had been accused of being a “suspicious character”. Also, the prospect that one of my co-workers was the one who called security, really dampened the amount of trust I thought I had found within Presbyterian. All I knew was that someone in the building, maybe some people, thought I looked like a menace, and why? I was dressed the same as them. I interacted on a personable/professional level. And yet, someone thought I was up to no good, I was a layperson out to ask for change or steal something…

Once again I approached my supervisor. He advised me to contact the security office again, and this time, during my lunch break, I made the walk to front reception and asked to speak with the head security officer, who happened to be the man from earlier in the morning.

“I sub here. I’m usually at the main hospital. I don’t know why someone thought you were suspicious, but down there, when I get a call about-“ He looked me up and down at this. “Street people… they’re usually wearing hoodies.”

“Yeah, but I was outside the building and there were other people with hoodies on standing in the smoking section.”

“Look, I don’t know okay. I just answered the call. Marie here was the one that put in the request to check things out.”

I turned to the front receptionist.

“Do you know who called? I’d like to ask them why.”

“No, I’m sorry. I didn’t get their name.”

“Do you know what they look like?”

“No. Sorry.”

“Yeah, I don’t know what to tell you.” The security guard shifted back and forth on the balls of his feet as a sign it was time to drop everything and just move on.

“So, no discerning attributes about the person, no name, and you can’t tell me anything other than you got the call. Can I get your name at least?”

“Mike.”

“Mike? Mike, I gotta be honest with ya’ here, I feel like I was racially profiled.”

“You’ll have to take that up with HR, guy. I can’t help you there.”

And so I did. When I returned for lunch, I sent an email to their office advising of the situation and after a few days of back and forth, I was assured that a face to face would be set up.

Before my PCU training commenced, I was sent an invite for a meeting that would take place the same day as my Billing Specialist certification was completed. The night before, I prepared all the dates/times and other pertinent information regarding the incidents in question. And when I walked in the next morning, I was ready to plead my case. I was not ready, however, for a permanent job interview, which was set up by my supervisor for that day. The meeting with HR was actually a meeting with 2 department managers and a fellow CSR to determine if I was a good fit for the company.

I frantically prepared STAR format scenarios, spoke with one of the interviewers beforehand, and was adequately ready when the time came. Once again, my lunch break was an issue, and after making allowances with my schedule, the interview went very well. During the closing portion, I expressed my concerns with the security force there, and one of the department managers took great interest in the story, even approaching the Operations Manager about how to resolve everything.

“Ramon says that if HR doesn’t get back to you promptly, get a hold of him and he will intercede on your behalf. We don’t tolerate that kind of stuff here at Pres.”

After finishing my PCU training, I got a conference with HR scheduled, and an emailed notification that I didn’t get the permanent job. I was okay with this, considering I didn’t apply in the first place. I liked my weekly paychecks. I was leaving for vacation in Los Angeles, it was April, and spring was here. I left that Thursday (4/23) thinking my world was finally solidifying, that I could be that career-oriented person I once loathed incessantly. I was secure in a secure field, and Presbyterian was really looking out for me and the time they invested in my training.

It was Friday, 4/24/15. My wife and I were celebrating our 4 year anniversary, my birthday, no spinal meningitis, and a reading at Gatsby Books for Kleft Jaw on Saturday. Spirits were exceptionally high and of course for good reason, as we walked the back alleys of West Hollywood with complete abandon.

Suddenly my phone rang and when I looked at the number, I saw that it was the temp agency.

“Hi Anthony. How are you?”

“Good. Good. Just enjoying some vacation time. Yourself?”

“I’m okay… Listen, I hate to be the one to do this, but we got a call from David today.”

“Oh yeah?”

“Yeah. Presbyterian has decided to cancel your contract with them…”

“…Wait, what? I just, I mean I know I didn’t get the permanent job, but I just finished training on a new- Did they say why?”

“No. Just that you weren’t a good fit. I’m sorry.”

“I mean, I don’t get it. I was-“

“I’m sorry Anthony. But we can find you something else hopefully. As long as you don’t contact Presbyterian or go back there.”

“What about my stuff?”

“We’ll send someone over to box it up for you and you can come by the office today or Monday to pick up your personal effects.”

“Uhm, I’m in L.A. until Tuesday.”

“Oh… Really?”

“Yeah.”

“Wow, I’m really sorry to tell you all this while you’re vacationing. That’s awful.”

“So, that’s it then. I’m just not a good fit is all?”

“That’s what they said.”

“Okay.”

“Did you want to come by my office Tuesday to pick up your things?”

“Yeah. It’s funny though…”

“What’s that?”

“I had an appointment with the HR department on Tuesday, to talk about some trouble I was having with their security…”

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