Insurance company battles

Hi Nancie,

Obviously, Music Lover and I have had very different experiences in dealing with insurance companies.

What I suggested was what I have done to obtain "out of network" benefits.

Just to let you know, prior to my TAH w/BSO, I had to undergo several abdominal surgeries for intestinal problems. The complexity of my situation required that 2 surgeons (one from each specialty, i.e., not general surgeons) participate in my hysterectomy. This was hard for the insurance company to understand and despite the letters of necessity provided to them by my health care professionals, they weren't changing their position.

So, I called my Senator's office. They were quite receptive to helping me and did so in a timely manner when I explained my situation.

Perhaps, needless to say, you should do what works best for you.

I wish you all the best!

Hysterhelp

i saw the plastic surgeon yesterday. he said that insurance will not cover doing an abdominoplasty at all--- they always view it as cosmetic.

Help! my internist wrote a great letter in which he said it was dangerous for me to have the surgery elsewhere. the medical reviewer at admin. snip: name of insurance company removed for liability reasons> called my doctors office today and said that there were plenty of doctors near me that could do "simple hysterectomy". the nurse tried to explain this wasn't simple. they then gave a llist of 4 doctors who are providers. turns out i know one of them--- she is a reproductive endocrinologist. i called the other three and phones were answered like "infertility specialists". i called back my case manager and said--- this is fairly funny i want to have my uterus out and aetna wants me to have IVF and get pregnant. she told me there is nothing that I can do other than schedule a "doctor to doctor " review. i have done these for my patients and never lost one-- but it takes up half an hour of my time that i can't bill for, and i dont think my doctor is going to be willing to do it.

so is it time to call my congressman? thanks so much . nancie

Hi Nancie,

Just checked back on your post -- it sounds like it might be best to call your congressman -- primarily because it sounds like an administrative error.

Just remember to have all your information together.

Good luck!

Hysterhelp

GO NANCIE
The office mgr at my gyno's office called the insurance to pre-certify me. My gyno and hospital is out-of-network, which means they pay only 60%--she was livid. She said that they said that I could travel 30 miles to another dr/hospital to have this done. She told them that I have been HIS patient since 1982 and asked me. I told her that there is NO WAY that I would go elsewhere--this surgery is tuff enuff and I want the dr there that has held my hand and been understanding with me thru this. There is an emotional attachment to this surgery for me which hasnt been with the other surgery that I had(which I had in network). Give them heck--you go girl. I am cheering for ya!!!

Edna

Nancie:
Your post is a little confusing. The Case Manager said you could do a "doctor to doctor" review. Then you said something about "I have done these for my patients and have never lost one but it takes a half an hour that I can't bill for." Who is saying this? Your doctor? Is admin. snip: name of insurance company removed for liability reasons> saying your physician can do a "Doctor to doctor" with the Medical Director at admin. snip: name of insurance company removed for liability reasons>? If that's so - ASK your doctor to do this! If he's so concerned about your having the surgery at the out of network location, he should be willing to do this. Believe me, if you can get your doctor to take the time to talk to the Medical Director there and he can give a very good reason why you should have your surgery where you're going to have it, I'd be surpised that it wouldn't be covered as in network. If your doctor is complaining about 30 minutes of his unbillable time, ** wmuch would he charge you to talk to the Medical Direcotor?How much money will you save by having your surgery paid on an in-network basis? It's got to be more than 30 minutes of his time.

hi everyone,

my doctor did a doctor to doctor review, wrote two letters and they turned him down. they said the only way that would cover me there was if it turned out after the fact that i had cancer.

i know i was confusing. i am a clinical psychologist so i do the doctor to doctor reviews for my patients!!!!!

anyway, i saw another surgeon last night because I can't go on like this. he said my uterus is now at five months pregnant, and he is surprised i am not having more problems than i am. he was very thorough and kind, and he is covered by my insurance company. so i am having it with him. however, I still am going to complain about all the misleading information that my insurance gave me, including reassurance that if i did such and such it would work and all about maximum out of pocket expenses. what a mess. need to change my surgery date in my profil.e.