Got some very bad news

Kajoli -

I was only approved for 48 hours myself The dr. told me don't even worry about that. Once you are in the hospital, there are all kinds of ways to extend the visit Since I work in Benefits, I personally called my contact. She said hun, don't worry, your dr. knows what she is talking about!! My complaint was: How is it someone with a c-section gets a mandatory 72 hours by law but a MAJOR surgery is lucky to get 48???? hmmmm I believe the pre-cert guidelines are a bit outdated!!!

Good Luck!!!

Yes u sure do honey need some relief. I had to reply, I also got denied back in April due to the fact the insurance company (same co) said there were other options that needed to be done before a major surgery was performed. I was willing to do anything to ge some relief. Someone here on this site said to get a second opinion and thats what I did. The new gyno agreed that I needed a hyster and said he needed to perform a d & c first to see if it didn't correct the problem (he knew it wouldn't) but that's how u have to work with the insurance. Well 2 months later I went in complaining about the same pain and he said they wasn't gonna stop us now because it was a medical necessity and my value of life needed relief and he has done all that was required to have this surgery.. Three weeks later I had the surgery and now I'm doing great (NO PAIN) and I am 3.5 wks PO. I have some little discomfort from recovery, but it's a heck of lot better than all of the pain I have been going thru for the last 25 yrs. Get another gyno and start there and also tell them that u were denied the operation.



Lisa

Don't fret kajoli I went home approx 16 hours after surgery and was soooooooo glad i did...................

kajoli

I wouldn't worry over it. It depends on what the DR says if he says u need another day they will take care of it. That's what my doc said anyhow. I went in on a Monday morn at 5:30 and came home at 11:30 Wed. My insurance said I was allowed only 2 days. Guess my Doc came thru.

I just took it upon myself to call and find out what's going on...was told exactly what you all have said I am preauthorized to stay 48...and further medical necessity will allow more...good lord , I agree with you also on the fact that this is major surgery and would love to see the heads of these insurance companies go through this lol ...well at least the thought of it made me smile....

Ok here is the latest......

FINALLY got in touch with a REAL person at the insurance company. This girl "claims" that my doctor did not call to get anything preauthorized. When I told her the name of the person my doctor spoke to she was like well, it isn't in there etc. Anyway, this girl tells me that she doesn't see anything on my file as pre-existing so she doesn't understand why I am telling her all this. I go into then how my doctor said I need this surgery, etc. She then tells me that well, the office will have to call and get it all preauthed. Ok....well, did I not just say they did and they were denied?! Hello people.......anyone home?! So after I felt like I got absolutley nowhere this girl I called my doctor back and told her about this.


She was so mad. She said they did call the insurance and she knows what they were told and she wasn't too happy. So she is going to call them back later today and see what they have to say. She said it sounds like we are getting the run around with the insurance company and she will not tolerate it. (I say good for her.....glad I have a doctor on my side!)

So I am playing the waiting game again. My doctor said she would call me this afternoon if she got through to them and let me know what was going on. The other option she mentioned to me was to go on and have the surgery since I need it and we fight the insurance company if they try to deny it. I am not so sure I want to do that because I can't imagine having to come up with that much money should they deny it over and over.

So girls......thanks for letting me vent and I will keep you all updated.

But I still think insurance companies are a rip off.

I'm so glad you checked. Now it just sounds like formalities and jumping through their hoops. It is rotten that you have to do it, but it's better than having to cancel surgery. It sounds like the insurance company dropped the ball somewhere, but they don't have any objection to the surgery, so try it again and it should go through. Good news...Yes, still a pain, but it sounds promising!