Upcoming hysterectomy 7/20: Insurance denied an overnight hospital stay...

I got a notice from my insurance that I was denied inpatient care in the hospital although they said they would cover the hysterectomy. I am having a laproscopic/vaginal hysterectomy. They said they do not feel that I would need inpatient care and that I could have this done outpatient.

WTH? I am mortified--I have been with my sister after hers and she was in pain--I can't imagine using prescription meds instead of the big guns that they use in hospitals and what if I have complications--then I will have to wait on an ambulance and my husband isn't a nurse.

I am shocked and have never heard of this. Have to wait till Monday to call my doctor. I am scheduled to have surgery on the 20th.

Hi Di_

Take a deep breath. First of all I had a LAVH and I wanted to go home the same day and I did. I had to be able to urinate, walk, keep down solid food, and have my pain under control with oral meds. However, my doctor told me that had I still had pain I could have stayed the night. The odd thing about insurance and overnight is that they will say -" same day surgery" and that just means you get 23 hours. Twenty three hours is often plenty of time with a LAVH. Also know that if you have complications or bad pain or nausea (which I hope you don't - I didn't) the hospital can request more time from the insurance company based on what is going on. This is just an initial guess. I had a recent surgery not related to hysterectomy. My insurance approved 48 hours. I was in for 3 nights and 4 days because I had some problems. Insurance is covering the extra time because the doc called and explained why I needed it. So don't panic. Chances are you may want to come home like I did, or 23 hours will be enough. It isn't as definite as it sounds.

I recently had a LAVH and my overnight was covered as "outpatient observation." What the difference is, I have no clue, but insurance approved the "outpatient" stay. They say it's time for the doctor to decide whether to discharge you or admit you as an inpatient.

My personal experience is that I probably could've went home that evening but I did feel more secure knowing that if something happened overnight, I'd have help. (I live alone.) By 8:00 that evening, my catheter was out, I was peeing like a horse, eating a regular diet, and up walking unassisted. Now, I know that everyone is different and there are women who still feel they can't bend over after a week...hopefully you will be one of the "super healers!!"

Ask your doctor about doing an overnight observation. Maybe the hospital will approve that. Good luck!!

I would love to have gone home, slept in my own bed, had better food, etc. they are not going to send you home if you are not in a condition to go home, so try not to worry too much. I was not in any pain when I woke up, and they weren't giving me any narcotics at all. Wishing you a successful surgery!

	Quote:
Originally Posted by Di_ I got a notice from my insurance that I was denied inpatient care in the hospital although they said they would cover the hysterectomy. I am having a laproscopic/vaginal hysterectomy. They said they do not feel that I would need inpatient care and that I could have this done outpatient. WTH? I am mortified--I have been with my sister after hers and she was in pain--I can't imagine using prescription meds instead of the big guns that they use in hospitals and what if I have complications--then I will have to wait on an ambulance and my husband isn't a nurse. I am shocked and have never heard of this. Have to wait till Monday to call my doctor. I am scheduled to have surgery on the 20th.

There is a difference between "inpatient stay" and "observation" stay. I had TLH with BSO and stayed overnight as an "observation" which is technically more like an outpatient stay - meaning they bill it differently to the insurance as opposed to the inpatient. I had all the care like postoperative unit and a great room, but I was feeling well and ready to leave next morning 10 am, which was less than 24 hours after surgery = observation.
And they will not discharge you if you do not meet the criteria after surgery like being able to void, pain controlled, nausea controlled, stuff like that.


What the insurance is doing is this - they just try to discourage doctors from automatically admitting patients as inpatient after surgery like that. But let's say things are not as expected and you have issues that warrant a longer stay in the hospital the case manager in the hospital will contact your insurance company and get approval (and if you have issues the insurance will ask the case manager to submit data but this is all done without you knowing).

Also, if you develop issues for whatever reason that warrant a longer stay in the hospital but you feel they try to kick you out talk to the surgeon and the case manager. The hospital has to make sure that they do a "safe discharge". They can not send you home without pain being controlled for example.

Just call your doctor and talk to the doctor about the insurance, I am sure the doctor will be able to explain everything.

I had a LSH with a 4" bikini cut incision, and mine was scheduled for "Outpatient". I was petrified!

As others have said, the word "Outpatient" means less than 24 hours. So it does include a one night stay.

Are you sure your insurance denied an overnight stay, or did they just specify "Outpatient"? Which allows for a one night stay, checking out the morning after surgery.

Even though I had the 4" incision, and my surgery was late morning (11:30 a.m., woke up at 3:00 pm), I was soooooo ready to go home by noon the next day.

Hello all and thank you for all the replies

They said that coverage for inpatient care after an outpatient procedure has been denied because the surgery that I am having done does not show a need for inpatient care. It says the care I need can be provided without inpatient care.

I think you all are right, what I consider "inpatient" is different than their definition and also they call this an outpatient procedure; however, at my hospital, regular surgeries are performed at the main hospital and outpatient procedures are done at the annex. I am having this performed at the main hospital and my doctor said inpatient.

I will call just to verify tomorrow (don't want last minutes surprises) and I know they sent my doctor the same notification and they didn't mention it so I am sure it is standard.

Thanks for replying and making me feel better--not having to wait and worry. I am spending this weekend and next week preparing stuff and even though I keep telling myself this is not a big deal I am starting to feel a bit emotional. The irony is that I am due for my period four days before surgery so this is the worst possible time for me to be emotional! I really hope my last period is not too much, I have had fibroids for four years and have gone from refusing to have a hysterectomy to the point that I think it will be a relief. I did try the myomectomy, which was largely unsuccessful.

Many thanks

Mine said "outpatient" but was performed in the main hospital.

I was so confused by this, and I was so nervous that they were going to try and discharge me immediately after, but it remained "outpatient" and they wheeled me to a room right after.

I think it's just the verbiage that's used. Good that you are confirming it.

Based on posts I've seen on this forum, a 23-hour stay seems like it's becoming the new norm for insurance companies in regards to hysterectomies. On a side note, my iPhone tried to auto-correct hysterectomy to Hyatt. Too bad the insurance companies can't send us to a Hyatt to recover instead, lol! It is a little mind-boggling what modern medicine can do! I had major knee surgery a couple of years ago. My kneecap was totally dislocated and the only way it got back into place was with a donor ligament and two screws. I was told in advance that I might require an overnight stay. I was vomiting from the anesthesia and in a lot of pain, so they kept me overnight in an observation room. They discharged me around 10:30 the next morning. On the other hand, when I had my gallbladder out, I was sent home within a few hours.

As others have mentioned, they won't send you home until you can urinate, pass gas, keep pain under control, walk stably, etc. If complications arise, they can always ask for extra days. I'm guessing a lot of this stuff has to go through prior authorization with insurance. If you really don't feel comfortable being sent home after your hysterectomy, make sure you let the doctors and nurses know. Good luck!

Normally my network does not cover the hospital where I am having surgery, but my insurance did approve. i'm sure they know my surgery is at 1:00 pm, so there's no way I could go home same day. Barring unforeseen circumstances, i expect to go home the following afternoon.

REALLY strange part is; my insurance will NOT cover follow-up at same hospital (outpatient not generally covered).

I am covered in doctor's office which is NOT in hospital. Also i would not be able to go to that hospital for any type of post-surgery rehab.

Medicare-types of insurance sucks most of the time.