What can I do about terrible office staff for a doctor?

February 15, 2018 8:27 AM

Is there any recourse available against a doctor’s office whose staff is incompetent and neglectful? More details inside...

So my mother needs to have a spinal fusion done in her neck. She’s been in extreme pain for at least 5 months and has been unable to use her right arm through this entire period. This question is specifically about the surgeon’s staff. Here’s the story:

End of December my mother finally gets in to see an orthopedist at an appointment she’s been waiting two months for. Orthopedist recommends and MRI, which showed that she needs a spinal fusion in her neck. They find a surgeon in her network by the first of the year. The surgeon needs a referral before anything can be discussed but they assure her they do take her insurance. So now she’s been going back and forth between the insurance company (BCBS if that matters) the orthopedist and the surgeons office to get everything in line.

She gets insurance company approval this week but the surgeon was still saying they hadn’t gotten the referral. She finally gets in contact with the orthopedist again who say the sent the referral on Feb 1. This morning she calls the surgeons office who tell her 1) they are no longer taking her insurance since the beginning of the year and 2) they got the referral on the 1sr but since they don’t take her insurance they threw it away. No one called her to inform her of this and no one has told her that they insurance situation changed in all the conversations she’s had with them up to this point. So now she’s been working with this surgeon for no reason for a month and a half, all the while not being able to perform ADL’s due to the extreme pain.

This is the worst case but I have experienced many more horror stories of negligent or incompetent office staff before (i.e. not calling in a pain prescription after a Friday surgery which means no pain meds all weekend as one example)

Is there any recourse to be had against the staff of a doctor? I don’t think it’s appropraite to complain to the medical board since it’s not actually an issue with care, but feel free to correct me if I’m wrong.

All of this is happening in Texas.

posted by LizBoBiz to Health & Fitness (11 answers total)

You can let the doctor know their office staff is the reason you're finding a new doctor. You should know, though, that clerical medical office people are very poorly paid in general. It's hard to find good people to take those positions, much less stay in them and do a competent job. The doctors probably already know there are performance issues.
posted by something something at 8:32 AM on February 15, 2018

all you can do is tell the doctor about the terrible result for the patient and specifically which staff member was responsible.
posted by fingersandtoes at 8:58 AM on February 15, 2018

I mean, this sounds like pretty standard stuff for every doctor's office I've dealt with, and I've dealt with a lot. You can tell the office manager about your problems, but they can't/won't do anything besides maybe apologize. Unfortunately, the onus is on you/your mom to make sure insurance is accepted, referrals have been made, appointments have not been cancelled/rescheduled without notice. It sucks, but that's the US healthcare system.
posted by misanthropicsarah at 9:23 AM on February 15, 2018 [1 favorite]

Response by poster: I get that it’s on us to make sure insurance and referrals are taken care of but every time we talked to the staff they say it’s accepted until 2 months later and then it’s not and hasn’t really been for most of the time we were talking. And when your doctor keeps saying they sent the referral and the other office says they haven’t gotten it (when they actually did and threw it away instead), we were doing our part to make sure things were where they needed to be. The doctor’s office for their part either lied to us, or didn’t even tell their own people what was going on.

Re: changing doctors, of course she has to find a new one now because they stopped accepting the insurance.

So if there’s no official person to complain about the staff except to the doctor or office manager, then they are the ones responsible for the staff, right? Is there anyone higher than them that can hold them responsible?

(I know US healthcare is fucked up but it’s still finding new ways to surprise me with it’s fucked- upness)
posted by LizBoBiz at 9:35 AM on February 15, 2018 [1 favorite]

No, sorry, there’s really no one else to complain to unless it’s a practice owned by a hospital group (and you may not know unless you ask). In that case, you can usually find some sort of patient liaison at a corporate level to complain to. Incompetent staff can really negatively effect a patient’s health- I wish more physicians realized this truth. Best of luck.
posted by PorcineWithMe at 10:16 AM on February 15, 2018

Is the doctor's office part of a larger health care network? They might have an ombudsman you can talk with. Also, Yelp reviews for doctor's offices are a thing.
posted by soelo at 10:17 AM on February 15, 2018 [1 favorite]

they got the referral on the 1sr but since they don’t take her insurance they threw it away

This is unacceptable and crappy. I find it unlikely that a medical licensing body would see this as within their purview, but there's only one way to find out. And even if they didn't, I think knowing that this resulted in a formal complaint would cause everyone else involved to take this very seriously.

Is there anyone higher than them that can hold them responsible?

Not unless they are part of a bigger practice group or a component of a hospital or something, but I feel like you would already know about that.

not calling in a pain prescription after a Friday surgery which means no pain meds all weekend as one example

You should expect that you have a way to have medical staff paged for urgent matters after surgery 24/7. To get a phone number that will either connect you to a registered nurse or let you leave a message for an on-call physician. When you find your new surgeon I would ask about this.
posted by grouse at 10:19 AM on February 15, 2018

Things you can do: Yelp reviews; Google reviews; telling the orthopedist that they should stop referring any patients to this terribly mismanaged office; letter of complaint to surgeon sent via registered mail; vent on social media.
posted by Iris Gambol at 10:34 AM on February 15, 2018 [7 favorites]

i think part of it is BCBS/Anthem. i work at a university in rural virginia and BCBS just 'gave up' on negotiations with the closest major hospital system last month that a large number of our employees utilize. we did have warning from HR that negotiations were going poorly but again, that notification came from the customer/insurance side not the doctor side.
posted by noloveforned at 12:00 PM on February 15, 2018

It sounds like this is an issue with the insurance company, not the doctors office? They should certainly not have thrown out the referall but beyond that it does seem like they were working with the insurance company to try to accommodate your mom. I'm sorry, dealing with insurance crap is a nightmare.
posted by pintapicasso at 3:16 PM on February 15, 2018

Response by poster: Thanks for the responses here. We’re going to talk to BCBS and also the referring doctor to let them know what’s going on with this place.
posted by LizBoBiz at 5:43 AM on February 18, 2018