Really Depressed!

Hey sisters, I am in tears right now , have been since I got the call from actually my DR, not any of the office help actually DR called me on my cell phone around 6:00 tonight. Thought things were smooth sailing,,,,,, I had my pre-op this morning, Talked with DR about many things did lab work the whole nine yards, even told her about this web site and she actually even said it sounded like something she would approve for future women who needed a hyst. She called to tell me that she had been on he phone wih my insurance and that they had denied my preauth for the TAH......she had been playing phone tag with the insurance DR who denied the claim....She told me in the years she had been practicing, she has never had a denial, that if anything my case was one of the ones who needed it ASAP. She took my chart to her partner who has been doing this for many many years and she told her that just looking at my chart since I have been going there, it would warrent a TAH that not even counting my 13 years of suffering prior to going the their office. I dont know, I just should give up, I have never been a quiter, but since the surgery has already been reschedule a total of 3 times, it seems that its not meant to be......The thing is I have really good insurance and pay a dang good price for it. I would only have to pay $500.00 for the entire TAH (copayment for inpatient) Not to mention, My husband has insurance on me thru his work, The Humana plan. She said if push came to shove, they could see if Humana would pick up the tab costing me approx $1500.00 deduct and then 20% - Like I said , I'm about ready to give up. Oh yea I forgot to say, I was planning to have a TT in which was setting me back approx $6000.00..........In which I have already paind the PS fee along with the additional athes fee, only thing I hadn't paid yet was the additional hospital fee for the OR. Stick a fork in me I'm done fighting....Mel

Call the insurance commisioner for your state. Eavery state has one. They are there to help in situations like this. That is the craziest thing I have ever heard. It is a sad day in America when we are denied needed medical attention by an insurance company. What happened to Dr. deciding what their patients needed? That makes me sick I will keep you in my thoughts and prayers. Good Luck.

I had almost the same trouble. My insurance denied my claim and said my surgery was unwarranted.

After my doctor talked to the doctor at the insurance company, they approved it.

I hope the same works for you.

Good Luck.

Nina

((( Scaaty ))) don't just give up! I've heard from many ladies that their insurance was first denied and then approved after an appeal. It could be something as simple as a problem with the paperwork from your dr. Please try to find out why it was denied and then you'll have something to work with. It sounds like your dr should be willing to work with you on this. I'm sending lots of prayers and good wishes that you can get it resolved quickly.

S

Dont give up! Get on the phone and find out the reason. Can you also submit your records from the past 13 yrs of pain and problems?

Dont let the insurance company win!

The sisters are right, your doc can file an appeal. Also your ins. may require a 2nd opinion for approval. I used to do billing for gyn years ago. Don't give up, sometimes it's just part of the game.
Hang in there.

I'm so sorry that you are having to deal with the pain and burden of "bureaucratic red tape" on top of 13 years physical pain and the "normal" stress of an upcoming major surgery that is as emotionally charged as a hysterectomy. I'd say more but I would be censored.

Please don't give up, get on the phone and if you don't get satisfaction from the person you are talking to, calmly but firmly ask for their supervisor. Be persistant... go up the food chain to the very top if you have to. I hate to say it but there is some truth in the addage that "the squeeky wheel gets the grease", but try and do this in a way so that they don't have an excuse to not help you (such as cussing them out - which at this point I'd be sorely tempted to do)... try and help them find ways to become your champion. Remember that each beaurocracy is staffed by people who should be trying to help their clients... try to get them to relate as a person. I work for the government (a classic beaurocracy and I have drilled the concept of we REALLY ARE HERE to serve our constutients into my staff... so I know this is possible). Don't take No for an answer. Take plenty of notes (create a paper trail)- names, phone numbers, dates, what they say, etc. Documentation is critical in this situation. Please let us know what happens. My heart is with you.

Thanks sister for all you responses and concerns, I did have a phone conversation with the CSR for my insurance company and she was very much on my side, which was good for once, she seem to think that after the 2 DR spoke maybe all would be better. the CSR also stated that if the 2 DR keep playing phone tag then my DR should call into CS and let the head supervisor get in touch with their DR and then hash it out betweemn them. The CSR was very nice and seem to thing all would work out. Gosh I hope so, please sisters say a lil pray for me as I really need all the help I can get right now. I'm putting this in the Lords hands and he will do the rest. God bless each and everyone one of you...Melissa

Oh Scaaty, I am praying for you! Please keep us all informed! I am so thankful that you have this forum and can have access to such support!
Blessings,
Milaka