Need A Hyst But Ins Not Paying

Is there any help for me? Probably not but I had to ask. I need a hyst due to severe endo but my insurance is refusing to pay and the hospital says I have to come up with at least 75% up front. What is a girl to do? I've looked into medicaid, but I make too much. LOL I can't believe they say I make to much, when I can barely afford bills, but whatever. Is there anything I can do? Please help if you know anything. Thanks all.

Have you received a letter from your insurance company with the reason they have denied authorization for a hyst? Have you tried other treatments, and for how long a period of time? If your DR feels you have exhausted the other options is he helping you with an appeal?

I have never worked for an insurance company, and I never plan to, but in their defense - if you read your agreement with them they have the right to be sure that elective surgery, such as a hyst, is the last medical treatment that there is. Unless cancer is suspected a hyst is elective surgery. If it was entirely the bottom line they were worried about, they would say yes to every hyst before any other treatments were tried. The fact is they do get blamed for unnecessary hysts, some hysterectomy opponents say they are too quick to give the ok because they are worried about the bottom line and saying yes saves them money.

There is concern that in the past way too many unnecessary hysts were being performed without giving alternatives any thought at all. The medical community came under fire for that, and it can be said that the insurance companies are responding to that by making sure that a hyst is the last alternative.

There have been many members who regret having a hyst and blame their insurance companies for saying yes too quickly, especially if they have had continuing complications which were a result of the surgery.

S and best wishes.

I would have the Dr call the insurance company and go to bat for you. The Dr will have to send in medical findings for nurses and Drs at the insurance company to review.
If this is medically necessary, it cannot be denied. If the insurance co. finds that there are other options/treatments to try 1st, you may have to go that route. There has to be a valid reason the insurance co is denying your surgery. If you don't know that reason, you need to find out what it is. Then once you have that information, you will know better what to do.

I used to work for a health ins co, so I have some knowledge.


Nancy

They are refusing due to the doctor is not in their network. But the sad thing is there is no doctor in their network in this state. I can't afford to travel for a hyst, but I can't afford to pay out of pocket either. What to do oh what to do?

I would like to offer you some help, as in a different way I succeeded with the out of network thing.

If you can prove that there is no physician who can treat you in the network, the insurance company must pay out of network.

I had a situation where due to complex issues, I had to have diagnostic surgery out of network. Initially, the insurance company was going to charge outrageous deductibles, and denied payment for very technical blood testing which had to be done.

I wrote a letter, explaining very clearly what would happen potentially if I struggled, and waited for an in network doctor. I got my doctor to back me up. It worked.

I also have lots of experience with insurance. I think that they can find loopholes if they want. I think we can create loopholes if we are persistent.

And...again, most of the people you are dealing with at the insurance company are not very literate when it comes to this stuff. Many of the physicians involved do not actively practice. Many of the nurses have little nursing experience. You may be speaking to totally non-medical people.

start at the top!

Good luck.

Yasmina

Thank you so much, I will definently call them tomorrow and see what I can do. I'll also call my doc and see if he can try to help me, if he's not too busy. Thank you SO MUCH!
Sherry

I have to agree with getting a letter of notification from the insurance as to why they denied it. Then talk sweetly to the person in the doctors office about helping you to get to the bottom of why they won't help you when it is medically needed. ANd then if they still say no ask them why they can't seem to have somebody in network in your state do the surgery and why they won't pay since they don't have anybody on their list who is in network in the state. You have to be persistant with them. I had problems getting mine approved even though they said I had not done enough to prevent me from havin ga major in hospital surgery and they didn't want me to do it. I've been through so many treatments and they were persistant and I was even more persistant. Just remember to be sweet as honey on the phone when talking to them or else they could hang up on you and you will have to start over with the calls. and I hope things get straitened out for you.

I have to say that reading all the stories of insurance nonsense boggles my mind.

I have been approached a few times to work to help people who have insurance issues...like these.

I think when I am done with my medical crisis, I might just do that. I think there is quite a need.

I also think from reading this, that our society is biased away from helping women as much as men. I suspect insurance carriers are not as difficult regarding prostate surgery.

I may be way off. It probably doesn't matter.

To everyone that has issues with insurance, please fight back. It is my pleasure to get private messages from you. I think I have helped a few people already on the cite.

Yasmina

All Hail Princess Yasmina!! I agree fight back and get medical insurance to do what you want them to after all they work for you because you pay them don't you!

Thunderdog,

thanks for your positive note. I feel like a drowned rat. I have lost friends because of my medical problems, I am having problems at work, and at times my husband is being jerky.

So, thanks for a pat on the back. I really needed it tonight.

Yasmina