Complain about a product or service

Ear, Nose and Throat Associates of South Florida

Palm Beach Gardens

Kenneth of West Palm Beach, FL October 27, 2009

I had broken my nose several times and had bone fragments just under the surface on the bridge that often were uncomfortable and at times caused bleeding when disturbed.I also had developed a deviated septum which obstructed air flow significantly.I couldn't sleep well due to snoring and discomfort caused by this health problem. I saw an ENT doctor for this who suggested that I have a surgery to repair it. It was approved through Aetna health insurance. I went for a second opinion from another provider from the Aetna website, Dr Dedo. He said the same thing, that I needed a surgery to repair septum(septoplasty) and bone(rhinoplasty). I conceded and went through the steps all over to satisfy the requirements of Aetna insurance. Dr. Dedo said that to balance the changes, many people have a slight chin implant(geneoplasty, comedic only) at the same time. I agreed to pay for the chin work by check.

I went in for the presurgical workup just prior to the day of surgery. Dr. Dedo was abrupt with me and said that Aetna never pays him what he's worth and gives him a hard time paying even what they have precertified, so I have to pay him in full now for all services or he won't do the surgery. He said that when they pay him that he will reimburse me. I hesitantly agreed and wrote him a check, indicating on the check that it's for all three procedures.

After the surgery, when I went in for a follow up visit, I overheard him laughing with a employee that sometimes he can get paid twice if things work out right. I looked on the insurance website and found that he was paid for the two nose procedures. I called his office to inquire as to when I can expect to be reimbursed for my payment. I was told that they will get back with me on that. No word came. I contacted the insurance carrier and we had a three way call as which time they said that they will get back with me, and they didn't. When I contacted the insurance again, they gave the poor girl the run around about how they have to rebill it.

Now they have sent in a bill to Aetna calling this a septoplasty only and calling the rhinoplasty a cosmetic repair. Aetna said they had to pay it by law even though they understand my position. Dr Dedo has shown that he had no intention to pay me back and has rebilled this claim for one less procedure to protect himself and to spite me. he changed the diagnosis and procedure codes to indicate it wasn't a medically necessary surgery. There are some other contradictions in this case to further indicate his intent to commit fraud. His wife is his office manager and really seems to know the ins and outs and how to get away with stealing and not get into trouble for it. I sure could use some direction since I hate to let them get away with stealing from my family.

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