No Vax Decision questioned by nurse/ Child on OHP/

[orvis]

I live in  Oregon.  I up until my daughter was 14 months old, took her to a local clinic where my decision to not vaccinate was not looked down on (at least openly) and I simply filled out a form stating I was declining to vaccinate.  She is now 21 months old.  She recently came down with the flu.  We had placed her in OHP which is the Oregon Health Plan.  I had to choose a doctor as her primary care physician (outside of the clinic she normally goes to) whom she has not yet seen.

I called the Medicaid office first to see if I was allowed to bring my child to the emergency room with out the doctors pre approval as she has been throwing up and had diarrhea as well.  I was told that I would have to speak to the doctors office, and that if they decided the situation called for the emergency room then I would need a referral, unless it was life threading.  To me my child vomiting and diarrhea is an emergency situation.  So I took issue with the fact that I couldn't just bring her to an emergency room with out approval. 

Well, I called the doctors office and spoke with a nurse about the flu like symptoms.  She said I was not a patient since I had never been in, even though the doctors name is on my child's card as the PCP.  She said I would have to first come in to the office to fill out forms before I could even think of making an appointment.  I asked when I could do that and she said I might have to make an appointment to do that.    She also said my medical records had to be transferred to them.  She gave me advice about giving my child "pedylite"  but inferred it would be too expensive for me to afford.  She also said to cut out all milk and juice for then next 48 hours (my child is 21 months old) and she is only tolerating cheerios so for me to feed her only water and cheerios I would rather give her the milk even if I have to water it down for nutrition even if she will get diarrhea from it, its better then cheerios and water.  Well so my request to either make an appointment with the doctor, or to go to the emergency room was denied. 

Now on to the vaccination part: 

The nurse then demanded to know if my child had had an 18 month check up, when I replayed her last check up was at 14 months She asked if my child has had her vaccinations up to date.  I told her no my child hasn't had any vaccinations, to which she said 'none of them?" I explained to her she had been seeing a doctor and  that that doctor had said it was ok and that I had signed the 'refusal to vaccinate form", the nurse laughed and said ' we know they never say its ok" , she then said that this doctor my daughters PP, would not take patients who did not vaccinate.  I let her know that it was my choice, and she said that it was the doctors choice whether to take me as a patient or not.  She let me know that the doctor might call me back to let me know if she would decide to accept me as a patient..  I asked so the doctor or you will call me back then?  And she answered 'yes' I have not surprisingly, received any call back. 

This really concerns me as I can now no longer 'establish' my child as a patient there.  They apparently do not want Medicaid patients there, and definitely not ones who do not want to vaccinate their child.  Here I was a concerned mother for my child being sick and instead of the nurse being concerned about the diarrhea and vomiting storms.  I was given a lecture on vaccinations and made to feel like I'm putting my child in danger, when its the complete opposite. I understand they could not see my daughter unless her flu symptoms turned into dehydration.  I also understand I did not need more fear put into me about having to get my daughter vaccinated, and the nurse acting as if she's going to let OHP know that I am not getting my child vaccinated. 

When its my choice, they already know I sighed a religious exemption form too!,  Now I am worried about what is going to happen and why the nurse had the right to act like this to me.  Anyone else with a similar story and what did you do?  Thank you. 

I never experienced being treated this way about vaccine decisions and it totally threw me for a loop.  Oh and I thought this was a liberal state and that many other people are doing the same things as me and either delaying or not doing any vaxing at all.  In fact, my mother did the no vaxine thing  for me and her other children and we all turned out fine.

[ancoda]

Unfortunately yes the doctor can choose not to treat unvaxed children.   What I found easiest when lived in Oregon was to find a natropath that was willing to take payments and use them.   Mattering where you live in Oregon there are doctors that are more then willing to have patience that do not vax or have their own vax schedule, but I found that most of them are really hard to get into because they fill up so fast, and are not taking new patience very often.

[orvis]

My daughter saw 2  separate pediatricians in another state, (plus 3 other doctors at a clinical practice here) between birth and 14 months old.  Only one of those encouraged  shots, and I had never come across any one as adamant and condescending as this.  I live in central Oregon. 

Of course the physician has that right to decline patients, but usually its the other way around, the patient chooses whoe the PP is not the doctor refuses to see a patient as if this is some sort of country club hard to get on list.  In addition:  this doctor has open enrollment and is a doctor who is accepting OHP patients.

Also, I only got to speak to the nurse.  Should I really expect this to happen at most practices here in Oregon?  It would be really difficult for me to find out at the first of the month which practices have open enrollment, in OHP,  then call each one to find out their policy on vacs, and then have to deal with this sort of attitude with each one as if I'm doing something illegal. 

I saw another forum on no vax freindly doctors here, and there was only 1 name listed.

[ancoda]

I have lived in Roseburg, Bend and Portland.  The only one of those that I found doctors that would take non-vaxers was Portland. In Bend I knew of two doctors that would take delayed vaxers, but they wanted the kids caught up by the time they needed their school shots or they would drop you.  I never met a doctor in Roseburg that would take anyone not on schedule. I am not saying they do not exist, just that I never found them while living there.

I hope that someone who can be of help eventually sees this post and can be of help. I have been gone from Oregon for almost 2 years now.

[carmel23]

It is true re: the doctors being on the card are not necessarily the child's doctor.  I don't know why they print that on the card, but you have to call to see if they have room and "establish care." children's community clinic on killingsworth will probably accept an unvaxed child.  But a lot of the larger ped offices do not because they also have many children with compromised immune systems, etc. and cannot risk being exposed to anything.  Ours used to take non-vaxed children, but have since changed their policy. 

There are so many new children on OHP that it is really hard to get a into a good ped practice, these days.  The luxury of shopping for a good office on OHP is a thing of the past (since they expanded the program with "Healthy Kids")  You can try for "open card" and go with a natropath, but will likely be declined.

While it is a liberal state, the public health people are very concerned with an outbreak of  an otherwise nonthreatening disease (pertussis, etc.) that has been sidelined due to vaccination.  Because there is a pretty large population of unvaccinated children.

Good luck!

[orvis]

Wow well it is pretty silly to say a doctor has open enrollment through OHP, and then make me pick one, and then have me find out later, that that same doctor doesn't want to take all patients on who sign up with the PPP, therefore making me a pick another one at the first of the next month, while all the while, my child who I thought at least was covered, even if my husband and I aren't, doesn't seem to really be covered by any health plan at all, let alone able to even be seen by a doctor. 

I should not be denied medical care due to my religious beliefs, in fact I have never had any vaccinations myself, except for tetanus,  and I have not faced any problems at all about being able to see a doctor.  They never ask if my shots are up to date.

Pertussis causes aprx 25 deaths in most developed countries per year. It seems like public outbreaks in developed countries are relatively rare and far between.

I understand that more children are now allowed on CHIP, but it is hardly effective if the health care they are allowed is still not really available to them.  In other states, though they may have their own disadvantages, I have found that being able to go to any doctor you want and any emergency room just by stating you have medicaid or medicaid pending has been much more advantageous then this sort of broken system where you must choose PP who then do not even want to accept you as a patient, be it because you are on medicaid, or because you want to keep your child off of shots, or because they don't need any more patients.

To me, it is simply because they would only be giving her a check-up which costs less then the 27 shots that they would like to give her by the time she is 4 - 6 years old.  There is not so much money to be made off the occasional well check up. 

Going for an 'open' card seems to be almost impossible from what I have heard. Perhaps in the past it was a more viable option? I would rather just be able to have my child see a real doctor every once in a while.  I have nothing against Natropaths, but do not expect to receive that level of care on a public welfare type benefit.  I know that is not something I could even expect unless I could afford it, in which case I wouldn't need the OHP.

It seems to me, that it is a liberal state in outward appearance only, when you get down to how the system works here it seems to be geared more towards something else. It is a very strange broken set of affairs, though accessible in some ways: ie; you can ask questions quite easily of real people at the call center, and talk to a worker quite easily, in other ways, the actual application of the benefits in real life seem to be too convoluted with extra advocates and people who really are only all contradicting each other on what is or is not available. 

For example, calling to find out if something was covered, I have had a call center workers tell me 2 or 3 different answers, only to be told something else when I spoke to the patient advocate even though she wasn't too sure how far this benefit was covered either.  Well, with costly procedures, I'd rather not take a do it and lets wait and see who's  maybe right approach when its not known if a procedure is or is not covered. 

Thank you for your input, its comforting to know more details about what others have been though with this as well.

'

Edited by orvis - 10/13/11 at 1:04am

[carmel23]

Orvis, I also wanted to add, that I think that what you were told about not being covered because you hadn't established care with your primary provider was not true.  Sure, you haven't established care with *that office* but if you took your child into the ER for dehydration (which is a totally legit reason to take a baby to the ER!) and you child is approved, they cannot deny the coverage for that. 

Call the OHP office, or whoever is your care group (there are a lot of layers), for example if it is CareOregon, call them and ask who has open enrollment, or open spots for OHP patients.  Then call the office immediately and schedule an appointment to "establish care."  I don't think you need to even mention the vaccination status, yk? 

Good luck! 

[jenrose]

They can deny coverage for ER visits if you don't talk to a doc first.

Urgent care, maybe not so much.

Are you in Portland? In Eugene it's not impossible to find docs who will be comfortable with selective/no vacc. 

The idea that pertussis is rare is a myth. The truth is that pertussis outbreaks are pretty common, even deaths, but doctors don't recognize it because pertussis looks different in people who've been vaccinated but had the vaccine wear off. My daughter's whole school had it, and we never even got a note home, the only reason we knew that was what caused her cough was because I came down with full-blown whooping cough at 22 weeks pregnant a few years ago. Even in my case, by the time I was actually whooping and diagnosed, I'd already been given antibiotics for "walking pneumonia" and therefore was not testable for pertussis bacteria. The only reason we know it was definitely, 100% pertussis is that someone I exposed to the disease DID test positive 2 weeks later. 

All that said, we are still selective and extremely limited about what shots we will consider. 

[orvis]

I do need to mention the vaccination status ,I mean I wouldn't mention it If I didn't need to.  But I'll have to now, so that the same thing doesn't happen again, before I even attempt to add a PP.  .

Remember I was calling this nurse about the flu like symtoms.  It was like half way through she kept on asking me "did your child have her 18 mo. check up?', "why did you leave your last doctor?"  my answer to the last one "yeah ummm well I wanted to go to a real doctors office and not a community clinic"  Then she kept on asking, "Did your child get all her immunizations?, Is she up to date?".  I didn't answer her the first couple of times because it felt like she was baiting me, but then I answered to stick up for myself and my beliefs and that's when she was like "a ha I knew it, well this doctor doesn't take such patients anyways, so we won't see you at all"

I was told by OHP customer service that I must get my emergency visit approved by the nurse or get what they call a 'referral' or I would be responsible for costs incurred.

Thanks for your responses.

[janinemh]

My son is on OHP and we have a great family Nurse practitioner who supports our decision to not vax.  She is in Aurora.  If that is not too far away from where you are,  send me a PM and I will give you her info.

Janine

[orvis]

Hello, thank you but I live in Eugene, Or.  The doctors office I called was Helen Miller's it was a nurse I spoke with not sure of the nurses name.

[jenrose]

If you live in Eugene, check to see if Karen Weiner is taken patients over at Oregon Medical Group, Westmoreland. We use her. 

[orvis]

Well I just switched over to the clinic again, so I'll try calling OMG oh wait I forgot, they can't tell me if she's accepting new patients on OHP, I'll have to call OHp on the first of the month and ask them if she is on their list.  And I guess she is delay vax or no vax friendly then?

Thank you

[jenrose]

Actually, I'd call, tell them she came recommended, and see what they say. They SHOULD tell you if she's accepting new patients. She isn't always. 

[orvis]

Yes, well that would make sense, except I have specifically been told by OHP that only they have the list of Doctors that are accepting patients who take OHP.  I have called the doctors office and been told the same thing that they don't know if they are on the list or not.  I have to call at the first of the month to see because thats when the list gets open.

I'm guessing you don't have OHP then>?  Otherwise you would know how difficult they make it to actually pick & choose. 

Oh and I can only see doctors in the LIPA geographical section.

[babygirlie]

I'm sorry. I feel your frustration. If she is on OHP for sure and you were scared I would have gone to urgent care or the emergency room and simply stated her doctor has not been placed yet and I don't see any reason why they can deny you. Urgent care might be able to turn away people but an ER cannot. We've been duped before by poor secretarial skills... ones which cost dh his job! They also stated he was not allowed to go to urgent care (this was kaizer ins) and he would have to talk to a nurse and she of course never called or didn't know what to do. 3 days of missed work is an automatic firing from the company despite working there for 10 years. He was severely sick and risked it because he had faith this nurse and secretary knew what they were doing (he never established a doctor either. he never goes). So he lost his job then the nurse called the next day and said oh.. you can go to any urgent care you want to after all.

Makes no sense. no doctor; no referral so you are a free agent as far as I'm concerned. She's covered. Screw their rules... just show up. My kid also had that stomach virus it's going up and down I5. It's a pretty brutal one. I stuck it out but it was scary

The only way my kid got into her pediatritian was because she wasn't born yet!  They ONLY take fetuses here they are so busy (s.l.m). I am now very grateful for the doctor I have because while he believes in vaxing he doesn't blink when I say not right now. My key words are... are you up to date? YES  (according to MY standards my non vaxed child is 100% utd)   Or if pushed.. not today ty. Or she has a cold I won't vax when she's sick. Of course I won't vax if she's well either but that's not the point.  (and btw wic does NOT need your vax info.. sinply state you don't have it and she is utd)

Also I think by OHP standards you are allowed to see your doctor only on these well check visits so if you didn't do the 18m one she can schedule you in now so the ohp pays them. Or at least that's how it appeared to me.

I'm sorry she was such a witch. It's unfair for someone in that position to act so snotty lowly and uneducated. I would report her if you have the guts.

Again if you're not even allowed to see a doctor (nurse COULD have been talking out of her behind about the doctors there and maybe call when SHE isn't on duty or ask the front desk) until an established care appointment or GETTING a dr I would think you have every right to go in and if they charge you send it to OHP and tell them this is THEIR fault and you weren't risking your kid dying waiting a month to establish a doctor. That secretary had to have had it wrong. I remember what huge pains in the behinds they were. It was hellish finding a dr. in my town there is ONE doctor taking ohp and ZERO Ob's. Actually there was ONE RN that took it and when she moved a single doctor opened up. The hospital here actually allows midwives for ohp because well the fancy OB's are too busy. I met the worst condescending midwife ever and switched to the hospital one who were nice (she refused to deliver as their practice was being sued and lost all priveledges.. apparently that OB killed some babies :O!!! ) and sent me to an MD who worked with OB's. OHP is definately not for the faint of heart or people who care about their providers sadly.

[jenrose]

Originally Posted by orvis 

Yes, well that would make sense, except I have specifically been told by OHP that only they have the list of Doctors that are accepting patients who take OHP.  I have called the doctors office and been told the same thing that they don't know if they are on the list or not.  I have to call at the first of the month to see because thats when the list gets open.

I'm guessing you don't have OHP then>?  Otherwise you would know how difficult they make it to actually pick & choose. 

Oh and I can only see doctors in the LIPA geographical section.

I've been on OHP and have friends on OHP, and one of my friends gave birth recently and picked Karen for her provider. My sister was unable to at the time her baby was born. I do know it's hard to pick and choose, but I also know she's been open recently. 

[jenrose]

Oh, and I once had a blister on my eyeball and the ER refused to see me without a referral because of OHP, and I ended up saddled with the WORST doctor because he was the only one who would see me that day. We switched after that. 

[babygirlie]

wow that has got to be illegal! I thought it was the law ER never refuses anyone! ugh.

I had the worst toothpain ever and couldn't get into my dentist so I went to an energency dentist with my emergency stash. I was refused. They said it was illegal for them to take money from people on ohp! I think I cried in the car. I was in so much pain!

[orvis]

Wow that is exactly how I felt about the whole thing too.  Like if I was to go to a doctor, or bring her to a clinic, and even mention the OHP thing, but then just try to pay cash for a one time visit.  Like I would be refused to because I was on OHP.  I was thinking this health insurance thing is just a big fake.  I mean what's the use if I need to get a referell for everything?  Not even able to see a doctor for the referral either, which would be more reassuring then some nurse chastising me on the phone for my no vax decisions, when all I wanted to do was go in for a check up because my baby was sick.

Edited by orvis - 11/4/11 at 4:00pm