Help!!! Insurance question

I'm having TAH/BSO on April 27th. I just got the approval from insurance in the mail. I'm approved for the surgery and April 27-28 in the hospital. Does that mean I have to go home on the 28th or does it cover the night of the 28th? My doctor said I would be in until the 29th. Do I need to talk to <oops! no insurance company names, please> again?
Thanks!
Carolyn

Hi (((Carolyn))) You probably don't need to talk with them. It's normal to be approved for only one night in the hospital but then end up spending more. What happens is, once you're at the hospital and have had the surgery, they call and tell the insurance company you need to stay another day, and it gets approved then.

s,
-Linda

My insurance company approved me for only 2 days at first. After surgery, due to complications, my dr called the insurance company and I was approved for 5 more days if needed. I was only in for 3.

Cindy

It sounds like you will stay the night of the 27th and 28th and discharged on the 29th. It sounds like your doctor understands this (he does this every day!). If you want to call the ins. co. then do that. If you need to stay longer because of a complication, the ins. will pay

Hey Caro! I am in Puyallup and having my TAH at <oops! hospital name removed due to privacy/safety concerns> on the 27th. Such a coincidence (sp). I actually have spoken to the billing dept at The hosp and they are dealing w/ the insurance comp for me. I got full approval for the sugery but not appoved for any days in the hospital. I think it is just one of those things they do to tell you not to milk the situation and run up "their" bill; as if any one WANTS to be in a hospital one second longer than absolutely neccessary. Your Doc won't release you if it isn't medically safe so don't worry. Give the billing office at the hospital a call if you need to feel better. I wouldn't raise my blood pressure by trying to deal with insurance people now. The lady was real nice, she even offered to check on how much I had in towards my deductables.
Just think when you are all done, I'll be just going in. Best of luck.
Should I take a sweater to the hospital as I try to walk the halls? Will it rain? What are you doing? I hate the thought of going cold in a drafty hospital corridor....

Hi, I'm an old retired nurse that did hospital precertification for a (the) major insurance company in the United States a few years back.

The hospital precertifications are called in to the insurance companies sometimes as late as the day before the surgery. The surgeons and their staff have access to the different insurance companies criteria for each procedure. So they pretty much know what will and what will not be approved. The insurance company works from a set of medical criteria. Talk about unnecessary procedures being requested! Believe me, I've been on both sides of this story. It is frustrating to have a procedure you need turned down by an insurance company, but if you saw some of the reasons doctors wanted to to total hysterectomies a few years ago you would scream. I believe things are better now.

Anyway, I digress, back to my original story, the insurance company gives the assigned number of days for the surgery, 1 for lap, 1 for vag, 2 for abdominal and one of two thing happen. EITHER, the utilization review nurse at the hospital reviews your chart and talks to your nurse and calls the insurance company for the extra time you need OR the insurance company has a nurse of its own at the hospital who reviews your chart and talks to you and/or your nurse/doctor about any extra care you need. Sometimes negotiations occur. For the most part, the patient gets what they need. Not always, but usually. And, the moral to the story is: that is why you don't have to worry about how many days they authorize up front.

Now, if my explaination is as clear as mud, ask me questions and I'll try to explain.

Hi Caro

I work at a major insurance company and have been on both sides as well. When the DR call in for a precert they are only giving a number of days even though your allowed to be in the hospital as long as necessary long as its medically necessary. But they only pre approve you for a certain amount of days like fabricat7 stated. Vag 1 day, abdonimal 2 days. But if complications arise then the DR just calls the insurance company and they pre approve more days and just keep it going like that.

Its very stressful believe me and being part of the insurance company it can get very frustrating especially when the insurance company feels that is NOT medically necessary. Honestly I encourage you to call the insurance company to put your mind at ease. You have the right to know everything concerning your coverage.