Questions?!

Hi - I have some concerns & would like some input, please. I had a D&C & hysteroscopy last Friday (due to endo hyperplasia & polyps) - biopsy came back neg for CA, but I had proliferative, polypoid hyperplasia & also showed squamous metaplasia & chronic inflammation at the endocervix. I cannot take HRT due to a clotting disorder, & it was my impression , as I left the surgicenter that I would be scheduling a hysterectomy. gyne called several days later, & wanted me to immediately start Prometrium. My hematologist said "NO" & when I called the gyne back, I had just assumed that he had "forgotten" about clotting disorder. He informed me that my insurance required this standard treatment & would not cover a hyst at this point. I would have to wait 3 months, & redo this all over again.
Does this seem to be standard for insurance cos? He said that he was certain that this would recur & that I would need a hyst, but protocol was to wait the three months, redo & then do the hyst. I'm not understanding why I should go thru this process when the outcome seems to be inevitable. Any input would be greatly appreciated. Thanks!

Hi rorob,

My suggestion - call your health insurance company and ask them whether or not you need to try other medical treatments before a hyst would be approved. I know this may seem daunting and it might take some time on the telephone to get the answers you are seeking, but I wouldn't just take your gyn's word on this. I would ask the insurance company. Each of them are different, so there's no way to know for sure if your gyn is right.

Best of luck! Let us know what you find out.

Beth

I don't get it! If your hematologist said no this time to the Prometrium, then he will say the same thing in 3 months. What is Prometrium anyway? What will change in 3 months besides your condition?

You may have to enlist the help of your hematologist's office...perhaps a letter to your gyn's office stating his case which then the gyn can use in an appeals letter to your insurance company. Your gyn did a referral for surgery right? And it was denied?

Get to the bottom of what has been done...and what has not been done. Ask for copies of everything. Enlist the help of your insurance co. Get names, dates and extension numbers of everyone you speak to.

Meanwhile...seek out a second opinion, perhaps a specialist. Best of luck to you.