Can a surgeon charge me and my insurance company for a procedure not performed?
January 8, 2015
I went to an ENT surgeon to have my deviated septum and broken nose fixed. The surgery was not successful in that I still cannot breath from my nose. I have to have it corrected by another doctor. A different ENT I went to looked at my before and after CT scans and found that the deviated septum was never changed. From what my current doctor tells me the surgeon charged me and my insurance company to fix the deviated septum but he never touched it. Is there anything I can do? This was about 2 years ago in New York. The place of business is in New York, however, I currently live in Boston, MA.
Presumably, the insurance co. is not pre-approving this procedure when their records show they already paid for it, even though it wasn't done. The billing codes on your prior Dr's payment claim may have included (i think the procedure is called) septorhinoplasty. This could be just an issue of just clarifying with your insurance carrier what was done and what was billed for. They may be able to resolve this on an administrative level. You might try sending them the prior Op report and getting it straightened out (no pun intended). Best of luck.
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