Legal Question in Insurance Law in New York

I had a abdominoplasty 3 weeks ago. My plastic surgeon said if I had a hernia he would repair it while I was getting my procedure. After the surgery I asked how everything went beautiful. I said great. No mention of the hernia, however today I get an explanation of benefits in the mail and a check from my insurance company for a hernia repair. Something is fishy about that. I was never told I had a hernia, I feel that the doctor probably submits this everytime to get extra money and its really insurance fraud. Shouldn't he have told me right after if I had a hernia repair done?


Asked on 7/24/14, 10:39 am

3 Answers from Attorneys
David Slater David P. Slater, Esq.

Yes. Obtain a copy of your medical & hospital records to be sure what he did.

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Answered on 7/24/14, 10:42 am
SHAHRIAR KASHANIAN LAW OFFICES OF SHAHRIAR KASHANIAN, ESQ.,

I have heard similar complaints on many occasions. Call up your insurance company and share your concerns with their fraud dept. and let them handle it.

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Answered on 7/24/14, 1:00 pm
Kevin Connolly Kevin J. Connolly

Oh, very nice. Now consider this:

MD: I want authorization to perform an abdominoplasty on Patient X.

InsCo: Tummy tuck is excluded cosmetic surgery.

MD: Pt has a left ipsilateral hernia with potential to progress to incarcerated.

InsCo: ICD53.9 is approved.

*****

So you get an $8000 tummy tuck and [pay just the co-pay. And now you're going to destroy the doctor who helped you. You evil sack of nightsoil, I hope you get a post-op infection that dehisces and dumps your stinking guts on the floor.

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Answered on 7/24/14, 9:22 pm


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