TAH: Insurance Denial

Hi, Ladies. I need to vent and see if anyone else has experienced this. My dr's office called me yesterday to let me know that the insurance company denied my procedure because I haven't had biopsies and the ablation done. I called them yesterday and tried to explain to them that the ablation won't help with my pain or endometriosis as endo is on the outside not the inside. I also explained that the guidelines they are using are outdated and do not make sense. I have to wait until Friday when my dr. is back in town for him to call and talk to a medical director at the ins. company. For those of you who are Christians, would you please pray about this situation and that the insurance company will reverse their decision??

Thank you,
Brenda

Brenda I'm praying for you~

I am praying for you also.

I'm not Christian, but I'll at least put my thoughts toward this working out for you. Also, I have read some women who had this happen and their doctors were able to reverse the decision. Doctors can get pretty demanding and go to bat big time, sometimes! So I also hope that your doctor is that kind of doctor and will kick some butt for ya!

Good luck.

I'm praying for you. That is beyond belief!

I am praying for you also. That is unbelievable.

((hystertime))

I am sorry you are dealing with all of this right now! I am sure it is frustrating!

It is not uncommon for insurance companies to deny a hysterectomy prior to the patient trying various types of options and alternatives. If bleeding is a concern, they often want an ablation or D&C done first. If pain is a concern, they want various hormones or medications tried. A hysterectomy should be a last resort treatment and some insurance companies want to make sure it is really necessary before approving one.

Since a hysterectomy is not a cure for endometriosis, that might be one reason your insurance company is hesitating. And since adenomyosis is only confirmed 100% via pathology after a hysterectomy, maybe your insurance company is wanting more confirmation to prove that you are dealing with adeno.

Trying the various options and having biopsies done prior to a hysterectomy can actually be to the benefit of the patient. A hysterectomy is a major surgery with a whole list of risks and not all women have a happily ever after experience. Sometimes trying an option ends up working and a hysterectomy with all its negatives can be avoided! Other times, trying the options only postpones the inevitable. But by trying the options first, you don't jump into a major surgery unnecessarily. Too bad we couldn't look into the future and see what the outcome of each option, including a hysterectomy, would be before we try them!

For right now, I would suggest making a list of all of your symptoms and how you are affected by them. Also, note any options you have tried and how they have helped and didn't help you. Have this ready in case your doctor needs it when he makes the peer to peer call on Friday. Based on your symptoms and prior testing, your doctor may be able to get your surgery approved quickly on Friday.

However, do be prepared to have some additional testing or procedures done. Your insurance company may want more physical proof--for instance, how was your endometriosis diagnosed? Have you had a laparoscopy and had endo removed and sent to pathology? What options have you tried for the endometriosis? A path report confirming endo might help them change their mind about a hysterectomy or determine that excision surgery in conjuction with an ablation might be best for you. As far as the adenomyosis, how was it diagnosed? Have you had an MRI? What options have you tried to treat your adeno symptoms?

Another thing that could help is a second opinion. Since you have endometriosis, have you ever consulted with an endometriosis specialist? Having a specialist determine you need surgery could convince your insurance company that a hysterectomy is the best choice for you.

I know it will be easy to worry over the next few days but try not to! Spend some time with your family, do something fun, finish up holiday preparations, and just try to keep yourself busy until you hear from your doctor. It is possible everything will fall right into place. One of our cancer members used to post, "Don't waste a good worry!"

I am having the same issue with my insurance company as well. I was schedule to have my hystrectomy today and was told Friday that it has to be appealed. Which we are doing. I have fibroids which makes life unbearable at times. I will keep you in my prayers as well.

Prayers.

Sending you prayers