How do I dispute a co-payment for surgery that was needed because the first one was not done correctly?

Question

I had knee replacement surgery and, after many months of pain, the doctor discovered that the knee cap had moved down and to the side of where it should be. The second surgery was a success but I don't feel that I should have to pay the co-pay fee for surgery that was needed only because the first one was not done correctly.

Answer 1

I think you need to talk to a lawyer....also he will handle your co-payment.

Answer 2

Because you are saying co-pay, you obviously have insurance. The insurance company is the unit that controls co-pays. You are going to need to justify to them why the second surgery was necessary. All insurance companies have a claims dispute form, you will need to fill one of those out. Get plently of documentation for your side before hand, as these guys are notoriously hard to get to pay.

On the other hand, if the surgery was indeed done improperly, the insurance may decide to go after the doctors for improper billing. At a minimum here, you have a good case for malpractice against the doctor that performed the first surgery, and a lawsuit against the insurance company should they fail to work with you.

Answer 3

You can try to dispute the copay with your insurance company, but they probably will tell you to pay it. Part of the contract you have with your insurance company is that you have to follow their rules - which includes paying copays for services rendered. (Whether or not it was done to your satisfaction is irrelevant.) For a provider to waive a copay, it's considered discrimination and they can't do it - it breaches their end of the contract. Some do it, but they're REALLY not supposed to, and if they get caught by the insurance companies, it's considered breach of contract, and it opens up a BIG UGLY can of worms.