Soooo mad!!!

My surgery was scheduled for jan 21 insurance denied it...dr apealed it..still denied it...i dont understand how the insurance can dictate my health....i have a fibroid the size of a grapefruit..last year it was the size of a lemon..im always in pain...heavy periods...there gonna resubmit in a month but still...i want this thing out...i mean jeez when I lay down you can see it and feel it!!

That is terrible! Insurance companies have no clue but yet they dictate what procedures we can and can't have! We pay so much money each month to have it but when it is time to actually use it they won't let you! Hang in there and things will work out for you!!!

Insurance companies are in the money making business, not the keep our subscribers happy business. Of course some are better than others. Fortunately I did not have problems getting approval for my hysterectomy, but I did have a really hard time with a previous surgery. I stayed on the phone with them for about an hour 3 times a week for about 6 weeks. By the end, they were saying they were going to cancel my coverage because I had not updated my phone number properly. I told one of the claims representatives my new number, but apparently that wasn't the proper method. I finally got a lawyer friend to write a letter, listing all the excuses they had made not to cover my surgery and threatening to take action. A week later, magically my surgery was approved. I sincerely hope your problem doesn't go that far, but don't just take no for an answer. In my experience, if they can find an excuse to say no, they will. I wish you much luck, and I'll keep my fingers crossed for you.

I am really surprised that insurance company would deny this procedure--especially since in my own case, the dr was concerned about the fibroid being or becoming cancerous in the future!

The kicker is I have really good insurance...im a federal goverment worker...blue cross blue shield federal insurance...ive never had issues with them in the past...been with them 15 years!!! Im gonna fight...just wish I didnt have to!!

I'm surprised that Blue Cross Blue Shield is saying no to the procedure. I have BCBSNC not a federal one but they are good. I'm still waiting on them to tell me how much they are going to pay for the surgery.

I have Blue Cross as well, and they didn't blink an eye about slapping down 35 grand for the surgery. I have been pretty low maintenance for the past 25 years though--don't know if that counts for anything. I'm sure they had to reason out that a hyst and very short hospital stay now would be a lot cheaper than cancer treatments in addition to a hyst and long hospital stay in the future. Just good business, you'd think...

Wow I am so sorry you are going through this. I do not understand how they can deny something your doctor says is medically necessary. With a fibroid that large its not like you are having an elective surgery. A hysterectomy is not a face lift for gosh sakes. My insurance did not even bat an eye. It took 5 minutes for the hospital to get the preapproval but we have union insurance that is amazing. Good luck fighting them.

This may seem silly but check and see what CPT (Current Procedural Terminology) code your surgeon used. Yes, his office should be more expert at it than we are but they may be using the wrong code or the insurance company wants more proof that you need the most invasive surgery. I notice you are having the TAH which I think makes you an inpatient which needs the precert....is your insurance company insisting you should have a less invasive procedure - like they, of course, should be able to make that call. I was surprised to learn that my DaVinci LAVH is considered outpatient and doesn't require pre-approval, yet I believe it is very, very costly. If as the procedure gets underway and converts to a TAH or it becomes necessary to keep me for more than the 23 hour observation period, the hospital has 24 hours after that to then call and get the authorization because I gather by then it will be seen as medically necessary since I'm already there and already in distress and the less invasive procedure will have failed. As much as I'm sure you don't want to involve your human resources department in your personal life, your employer has entered into a contract with the insurance company and HR might be helpful in arguing for your surgery (if that is their role to insist that the insurance contract be honored) saying that an absent employee in too much pain to go to work detracts from the work effort. Not sure how this works with a contract such as yours but my state has a state office to lodge formal complaints against insurance companies. Have you called the insurance company yourself and gotten an explanation from them asking what CPT codes are being used? Whether they want more "proof" for the procedure chosen for you? Yes the whole thing is obnoxious, and I'm sorry you are having this experience.

Thank you everyone for the support!! Really appreciate it!!