Sandy Santiago of CalPERS health benefits office directs me to call "hot horny girls"

CalPERS really loves coming up with pranks to fool members who are seeking help with health problems! First it was a fake 800 number to which I was directed to send faxes. It turned out it wasn’t even a fax number, and none of the faxes went through. Thank goodness I started faxing the day before my deadline for filing! I got it straightened out on time.

Sandy Santiago sent me a January 4, 2012 letter in which she directed me to call (888) 466 4000. This number directed me to call 1 800 834 TALK.

This is what Sandy Santiago apparently wanted me to hear:

“Hey, there, sexy guy. Welcome to an exciting new way to go live one-on-one with hot horny girls waiting right now to talk to you. Lie back, baby, relax! And get ready to meet real local students, housewives and working girls from all over the country. Hundreds of hot girls! Call free all day and night ‘cause we love nasty talk as much as you do. Hot amateur voice and personals for just 99 cents per minute… or live one-on-one talk with a nasty girl who’ll do anything you want for just $2.99 per minute!...”

January 12, 2012 UPDATE

I tried to fax a response to Sandy Santiago, but I couldn't get through at the (916) 795 1513 fax line. So I called CalPERS Customer Service at (888) 225 7377. What followed was interesting, as is always the case when one calls CalPERS.

Here's a letter I sent to CalPERS about what happened today:

To:
“Leeanne”
Sandy Santiago
Sandy Santiago’s superior at CalPERS

From:
Maura Larkins

Please consider the following to be a complaint and a request. I am requesting information on how to appeal Sandy Santiago’s bizarre decision expressed in her letter of January 4, 2012. In that letter she claimed that my complaint (that X-rays were not viewed by my doctors) was an administrative matter, not a health coverage issue. Her subordinate Salindra explained to me that Kaiser discharged its duties when it took the X-rays, and it had no obligation to view the X-rays or provide treatment for health problems revealed by the X-rays. In her letter, Ms. Santiago purportedly provided a CalPERS number for me to call, but it turned out to be a link to a “hot horny girls” phone sex line. Leeanne claimed today that she could not see Sandy Santiago’s letter on her computer. Anyone on the planet can easily see Ms. Santiago’s letter by Googling “CalPERS + Sandy + Santiago.” The first item that pops up in the results is my “Thank Heaven for Insurance Companies” blog featuring a scanned copy of the letter. Please also consider this letter to be a complaint about the unprofessional treatment, extending to outright sabotage, that I have received from Sandy Santiago and Customer Service. I have been given fake numbers to call and fax, and I have repeatedly received false information or no information at all. I request a response from Sandy Santiago’s superior.

Here is what happened today:

I called CalPERS and said, “I want to appeal a CalPERS rejection of my complaint regarding Health Benefits.”

CalPERS employee Leeanne put me on hold for several minutes while she “checked my account.”

She came back and said, “It looks like a letter was sent out on the 5th.”

I said yes, I had received the letter from Sandy Santiago. “How do I appeal Sandy Santiago’s decision?”

Sandy Santiago had opined that Kaiser Permanente had not violated its contract to provide health care for CalPERS members and families because once X-rays are taken, there is no obligation to allow Emergency Rooms doctors or other doctors to look at the X-rays or to treat the patient for problems revealed by the X-rays. The fact that Kaiser had taken X-rays was enough. Treatment is not required by the CalPERS contract with Kaiser!?! CalPERS often speaks of Kaiser as its “business partner.” I guess it’s a very, very close partnership.

Leeanne apparently did not want to tell me how to appeal Sandy Santiago’s decision. She said, “Just send in the correspondence you originally sent to the Health Plan, and the response you received from the Health Plan.”

“But I already did that.”

“When did you do that?” Leeanne spoke in a challenging, oppositional tone of voice.

“Around December 22.”

“Hold on a second. (Pause.) It’s not letting me view the information. Did you receive a response?”

“Yes, Leeanne, I received the response that you looked up a minute ago.” (Had she forgotten that she had just told me that CalPERS sent a response on the 5th?)

“I did not see the actual letter or the verbiage (pronounced “verbage”) in the letter.”

“Verbage?” I asked.

“Yes, verbage,” she said.

(I later looked up “verbiage” and found at DailyWritingTips.com that “three-syllable verbiage /vur bee ij/” is so frequently pronounced without its “i” that the non-standard mispronunciation is appearing in some dictionaries. I must bow to Leeanne for being on the cutting edge of our changing language.)

Leeanne then started speaking quickly, in a winding-things-up tone of voice, “That’s all I can tell you. There's nothing I can do--"

I could tell she was about to hang up on me.

“I want to speak to your supervisor.”

“Not a problem,” she said.

But apparently it was a problem. She hung up on me.

CalPERS Lack of Auditing of Kaiser Permanente Services

Kaiser Permanent employees labor under a draconian contract which prevents any physician or nurse who witnesses abuse or abandonment from notifying anyone of the problem.

CalPERS Lack of Auditing of Kaiser Permanente Services
Resulting in Patient Abandonment, Violation of Elder Abuse Laws
Sacramento, California
12th of Jul, 2011 by User936345

In many ways, CalPERS does an excellent job for California State retirees. However, that description does not extend to the monitoring of Kaiser Permanente, and the many systems Kaiser has in place to frustrate the reporting of retiree abuse, and abandonment. Obviously, CalPERS wants to hear good stories about Kaiser. After all, they are providing service to tens of thousands of State and local retirees. How horrible would it be for CalPERS to discover that the lack of complaints is due to the clever methods Kaiser Permanente has established for sheltering CalPERS from what they "don't need to know."

So what are these mechanisms that prevent nary a complaint from ever reaching CalPERS? They are many, including:

-A Member Services "complaint" system that can often take several weeks, a system that serves to defuse patient anger, but never results in a decision favorable to a retiree. So-called "resolutions" are simply word for word transcriptions of rationales supplied by offending physicians. There is never a meeting with a supervisor. Never a contact from the physician. The "case worker" analyzing the complaint has no medical training because she does not need any, since the finding is a foregone conclusion.

-An appeals process for Member Services "resolutions" to a nameless committee in either the San Francisco Bay Area or Los Angeles. These committees meet in secret, and the names of the attendees are never divulged to patients or their medical representatives. Again, a case worker without medical training is in charge of the paperwork, and, again, the result is a foregone conclusion. (CalPERS could well paper their offices with the stacks of denials resulting from these secret meetings.)

-RISK MANAGEMENT units: These groups are composed primarily of attorneys who are organized for one purpose only. That is, to reduce the risk to Kaiser Permanente from any patient who has been abused or abandoned. In Northern California, one may find this unit at Kaiser Plaza in Oakland. At the local level, a physician is normally assigned to a so-called MedLegal to refer patient "complaints" to RISK MANAGEMENT for burial.

-Ombudsmen: On each Kaiser campus there exists an Ombudsman. These individuals are typically either non-medical personnel or RN's who are very charming, but will tell patients immediately that they have no power to correct problems relative to medical care. Ombudsmen on Kaiser campuses are not respected by medical personnel. At best, an Ombudsman might serve as a traffic cop. However, if a patient has been abandoned, he or she will stay abandoned. If a patient has been referred to RISK MANAGEMENT, he or she will stay referred to RISK MANAGEMENT.

-THE CONTRACT: Kaiser Permanent employees labor under a draconian contract which prevents any physician or nurse who witnesses abuse or abandonment from notifying anyone of the problem. HIPAA rules and regulations having to do with medical information confidentiality are used by Kaiser in the same way as "national security" is sometimes used by the government, that is, to frustrate the ability of witnesses to have their information considered by proper authorities. In such an environment, it is unlikely that CalPERS will ever hear from all but the most persistent patients. (Illness, discomfort and other factors also play into the inability of retirees to be heard by CalPERS.)

Requesting a more aggressive CalPERS relative to Kaiser Permanente is the first purpose of this complaint. The additional purpose of this complaint is to notify CalPERS that its own systems for receiving and taking action relative to medical malfeasance are deficient. A much more immediate and less impersonal system needs to be designed. A five to ten day turnaround time for all complaints is simply inadequate. Routine surprise audits also need to be conducted by CalPERS of all Kaiser Permanente facilities. Further, the rating systems associated with CalPERS relative to Kaiser Permanente are out of date, and serve only to mislead both active and retired personnel into choosing a service that, as it is currently structured, is dollars vs patient oriented. CalPERS actions taken as a result of this NOTICE will be appreciated by all patient advocates, as well as Kaiser employees who are in positions to witness, but not to openly challenge, a system established for other than patient well being. Kaiser Permanente is not a hopeless organization. However, CalPERS, which siphons millions of dollars into Kaiser coffers every year, must be more diligent in making certain that the intentions of CalPERS and the delivery systems hired to fulfill those intentions are congruous.