Insurance Questions

Is there any reason that insurance will not pay for this surgery?

Could you perhaps be a little more specific? Has your insurance company refused to pay for your surgery?

There can be many reasons why an insurance company might refuse to pay for a hysterectomy, depending on the individual's coverage. Generally, though, if the DR makes a case for why the surgery is medically necessary, and non-surgical options have been tried and have failed, insurance companies will usually authorize it.

s,
-Linda

Probably because they think that you don't need it. Your dr needs to call and fight for you. To kind of prove that it is needed and that it won't go away on its own.

My experience has been that PPO's will generally approve hysterectomies with little or no fighting about it. A doctor can generally straighten them out if they do question it. It's the HMO's where people tend to run into problems, when office personnel assigned the task of keeping costs low attempt to override the doctor's advice. I worked as a temp at an HMO once, and I was shocked at the dissatisfaction from patients who were having trouble getting the care they needed.

That said, not all HMO's are as bad as the one I described. Each one is run a little differently, so don't judge them all by the bad management of a few. As was stated above, there are other reasons where an insurance company might question the necessity of the surgery. If that happens, ask your doctor to intercede for you.

My insurance had two pages of reasons they wouldn't approve. I am appealing, my doctor is appealing and we will win. I think they just want to be sure that this surgery is medically necessary for me. My Dr. only had her records, not any of my other Dr.'s. I have rememdied that.

Good luck to you. T

I am in the same boat as you, we are in the process of fighting it I am with a PPO, they are saying that this is a pre-x condition and in order to pay I have to wait until 5/2007, hello everything can fall out by then LOL.but pre-x is when this has been diagnosed and treated before, this is the first diagnose for me, whos records are they looking at, thanks for listening. good luck.

My insurance approved my surgery. I went through an unnecessary Lap on 3/1, they had approved my surgery upon recieving my demand for a second level review within 24 hours....So I won, but I had to go through an additional surgery.

I would have your doctor take up the mantle with your case, if they are saying pre existing, then they are saying that you had the problem before you came under your current insurance. I did too, but our insurance has a waiver that if you are treated for a condition within a year then the problem is considered pre existing.

I hope you find a way to fight this. Good luck, T