Suburban Orthopaedics

The medical staff is great but the admin staff is horrible. They make common practice of lying to cover their frequent failures, mostly associated with processing insurance authorization requests. I've had instances where they say the insurance company has approved a procedure only to find out later that they never submitted the authorization request to the insurance company. The risk there is that if a procedure is performed without an approved authorization request the insurance company can deny the claim and the patient is left with the full bill and no recourse. When they do submit authorization requests they are incredibly bad about following through on them. I currently have been waiting 18 weeks for an authorization request for one procedure. The admin staff says they are waiting on the insurance company to respond. The fact however is that out of 18 weeks the insurance company has only had this for action for about one week total. The rest of the time it has been waiting for the admin staff to process the next step. When the insurance company asked for additional information it took over a month before the admin staff sent the requested information. The insurance company quickly responded saying they still needed additional information yet the admin staff insisted they were waiting to hear back from the insurance company. I explained more than once that the insurance company was waiting for the additional requested information and asked the admin staff to contact the insurance company to get this worked out. The admin staff agreed they needed to contact the insurance company but they never did. This went on for another 6 weeks all the while I'm in pretty significant pain waiting week after week, month after month. Over the past 3 years I've been seeing 2 different doctors at this facility, a pain management specialist and a surgeon. Eventually I asked both of them if they could help get the admin staff to take some action. After that the admin staff decided to abandon the first authorization request that had been in progress for months and submit a new authorization request. The insurance company again asked for additional information. After 4 weeks the insurance company was still waiting to hear back from the admin staff. Then 3 weeks ago the admin staff submitted a 3rd authorization request for this one procedure that was ordered 18 weeks ago. As with the previous 2 requests, the insurance company promptly requested additional information and the admin staff has failed to respond. Three weeks ago one of the doctors told me they have had a meeting with the partners about this. They recognize there is an ongoing problem and are taking steps to correct it. That was the message 3 weeks ago but these 3 authorization requests sat in the same state, waiting for the admin staff, until the end of last week when I had another follow up appointment. In that appointment I raised concerns again that there has still been no activity on this in the past 3 weeks since he told me they were taking steps to correct the problem. The doctor left the room to investigate and returned with the Physician's Assistant who initially said he had already provided the requested information. After I ran through the timeline of all actions taken on all 3 authorization requests for this one procedure the story changed to saying the requested information hadn't been sent because the insurance company didn't outline exactly what information they wanted. When I pointed out that if he didn't understand their request he should have asked for clarification then he said they did tell him exactly what they wanted 4 weeks ago but that message was still unread in his inbox. He hadn't seen it until now. He said he would get the requested info sent out that day, which he did. There was an assistant office manage there a couple years ago who was trying to address these problem. Unfortunately he wasn't there very long. When I tried speaking to the office manager about the problems he told me I was lying and that I was just trying to cause trouble. He said all delays have always been the insurance company's fault without exception. When I asked him to get on the phone with the insurance company with me he kicked me out of his office. I have spent countless hours on the phone with them and the insurance company. Multiple trips to the doctor's office to talk to them about this in person. If it was a simple matter of human error it would be easy to fix the mistake and move on. Make no mistake about it, this is not a simple human error and is not a one-time event. Over a 3 year period the admin staff has demonstrated a consistent pattern of failures accompanied by a lack of concern. Most alarming is a consistent pattern of lying to cover their failures. It's excuse after excuse while the patient suffers and wait week after week, month after month. There are a few members of the admin staff who are good to work with. Unfortunately however their efforts are overshadowed by the failures of several others. Again, the medical care has been great. I've had surgery here along with countless injections and have been very happy with the results. Regrettably you only see that when you can get the admin staff to process the paperwork so the medical staff can work their magic.