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?
3 Answers from Attorneys
Yes. Obtain a copy of your medical & hospital records to be sure what he did.
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.
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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