Insurance Woes

I have a new problem... Just before I went into surgery, which by the way had been scheduled for over a month,
I called the doctor to talk about my sore throat... I didn't want the team to come if they weren't going to do surgery the next day... When I called my Dr's office, the girl said
"Oh, by the way, we still don't have authorization to do surgery". Between, her and I calling the insurance, she finally called me back the afternoon before surgery and said she had gotten authorization...Fast forward to yesterday.. I got a letter from my insurance that said they only would authorize 2 days and if that needed to be changed to contact them. This was a day after I got out of the hosp. after a 4 day stay.. Any ideas where I go from here?? I have a 6 -7 " incision from my belly button down to the pubic bone and on day two I was still on IV pain meds... There was no way I could have come home.
And they tell us not to stress!!!

Hi PattieO,
Doctor's offices deal with this all the time. The initial estimate is 2 days, if it takes longer, your doc just needs to send a notice to insurance company as to the reason for longer stay, such as complication, fever, or whatever. 2 days is a standard starting point. Insurance companies know it can change, your doc just needs to justify his reasons for keeping you. Best wishes!

Are you saying for a TAH standard stay is 2 days?? I didn't have a fever but I could barely walk... throwing up from pain meds, etc..
These insurance people are getting out of hand

Most commonly, 2 days is all they approve to start, unless there are complications or other procedures done at the same time. Don't worry, as long as your doc justifies your stay, you should be fine. Remember this is only a preauthorization. They will review medical notes to actually pay the claim. That is where your doc needs to document the reasons for longer stays. Insurance pays on diagnosis codes for inpatient stays and Medicare only pays 50 cents to every dollar billed. Hospitals have to pay good salaries to get good people and we all know about the prices of drugs and medical equipment. Insurance companies are just trying to keep medical costs down so they can keep premiums down. I suspect as long as your doctor kept up documentation of your problems in your chart progress notes, you will not have any difficulties with payment. (I have worked in hospitals for 27 years and to be honest the shorter the hospital stay, the less likely you are to get a secondary infection.)

	Quote:
Originally Posted by PattieO Are you saying for a TAH standard stay is 2 days?? I didn't have a fever but I could barely walk... throwing up from pain meds, etc.. These insurance people are getting out of hand

My said to expect 2 - 3 days in the hospital. BUT, between every time I got up to and the lack of passing. I was there 5 days.

I am not certain whether my HMO will question the length of my stay - haven't gotten that far yet - but my would verify everything because she came to the hospital every morning to see me.

I'd call the and let them know what you received so that they can address it with the insurance people. Good luck. It should all work out. The hospital records will show exactly what happened.

Blessings on you ...

Patti, You need to get on the phone with your doctor and explain everything then follow up with the insurance company. It's hard to rest when the bills start rolling in my haven't made it here yet...can't wait. But if your like me your only going to be off of work for so long and once you go back it's hard to find the time to deal with claims. Good Luck!!! Eileen

Thanks Robin... I was actually cut differently than my gyn. said because the gyn/onc wanted a better look at everything... he also took several lymph nodes. I don't know yet what he saw, won't see him for 3 weeks.. just my reg. gyn. to take out staples on Friday. I know we need to cut down on costs... I don't think I stayed any longer than I had to.. approx 3 1/2 days.
Suppose they'll count the 1/2 day as a whole one. Hah!

Eileen:
Thanks for the info.. yes I like to stay on top of the bills, they actually called me 3 wks before I went in and asked if I wanted to pay my deductible ahead of time. I said I could be dead by then and why would I pay before I had the service.. They said they do it as a convenience to the patient ...Hospitals are great... Hah..

I was a little worried about that too. I initially got a letter from my insurance saying I was preauthorized for an overnight stay in the hospital. My doctor had already told me I would be in the hospital for 2 days minimum, so I didn't know if I was going to get stuck with a bill for the second day. A few days later I got another letter from my insurance and they had approved the second day/night. I think as long as your doctor can provide a reason for the longer stay, your insurance should have no problem covering it. Good luck to you!