insurance denial and those of you going through that...

I just wanted to let you all know that my ins. denied surgery on Friday (bc bs) and after reading a few posts I decided to show up on my Dr.s steps early this morning as surgery was scheduled for tomorrow. Anyway my Dr. had a heart to heart talk with the Dr. at the ins. co. and they decided to let me have surgery without the endo biopsy. For all of you who might be having problems with Ins. talk with your dr. face to face...in my case thats the only thing that made my surgery go through.

I went through this to! And thanks to my doc and his excellent staff we got it taken care of! It is more stress added on to at a time we really don't need it but USUALLY it all works out in the end!

Thanks for your post!

Love & S

Sharon

Chalyndria,

What State do you live in? I am waiting to see if my surgery has been approved and I too have BC/BS.

Thanks
Dianne

I live in oregon but ins. is out of tennessee. However, I did read a post in here about a woman that was denied by bc bs and told to go through endo biopsy and she lived in massachutes I believe (you can type insurance denial in the search area to find her post. Good luck to you. If you do get denied... I showed up on DR. s doorstep morning pre-op (day before surgery) I went through pre-op and Dr. had it ok in about 4 hrs.

I have bc/bs and they denied me as well. I am in Ohio but my ins is out of Missouri. We fought with them for 3 weeks, filed appeals, and finally the doctor had a personal call with the deciding man at the ins. co. and I was able to get my pre-cert within a few minutes of the call.

I guess they really like to order that endo biopsy. Thats what they wanted me to do too!

Good news is that my surgery is over.. and the insurance paid like a man uptown! The doctor really does have a big influence on the ins. if he gives them a call.

Alright ladies, dont' hate me, but I got insurance approval for a TAH/BSO, panniculectomy with scar revision in less than 2 weeks. I have BcBs also in Ohio. I knew the panniculectomy is the same procedure as a tummy tuck and very well could have been denied. It's not a lie to my insurance company, but I was quoted prices for abdominoplasty......but the procedure was billed as panniculectomy (removal of fat pouch). They are both the same procedure just different wording. I am also just 41 and my hyster could have easily been denied........I've not had an ultrasound for years....but my fibroid are feelable upon exam as well as the ovarian cysts when inflammed. There has been documented pressure on the spinal cord as well as pain medications being increased over the years. It truly depends on what your dr asks for and his reasons for the procedure. I also made the effort to call my insurance company personally. They go through a medical company that does it's approval (precertifications). They would not approve the hyster till their medical director (some Dr behind a deskin Arizona of all places) reviewed the photos provided by my PS. I think the whole process took 10 days. It was a very nervous 10 days, but it was preferred to spending my hard earned cash.

Just a hint. Call your insurance company, ask questions as soon as your dr submits the request for coverage. Ask why dr requested the procedure to see if your on the same page. Just keep on them, it's your body and your right to know. I am starting to think I am very lucky........I know I am with the PS........ it's large, gross (to me anyway) and the scars are incredible from my 2 c/s, but it easily could have been denied. Keep on them and start early!

Good luck!