Concerned about paying for surgery

I'm 7 days away from my surgery and just received a letter today that my pre-cert was denied. I immediately called my insurance company and the pre-cert company, both were RUDE. I then called my hospital and found out what my route of action would be if the appeal was denied as well. They told me that I could still have the surgery as self-pay and once I receive the bill, to call and schedule a payment plan. Being that the payment plan is set up in to be paid off in 12 months, if that's not possible, then I qualify to fill out paperwork for finacial aid (because I live in the "right" city).

Of course, the poor RN from pre-op got my ranting and raving since she called no more than 30 minutes after it all. I appoligized and she completely understood. I didn't take out my frustrations on her, simply talked and talked and talked and she listened and responded. She made it very clear that I'm doing the right thing and whether I end up being self pay or not, to have my procedure done. So, I left a message @ the doc office (they close early on Fridays) that I recieved this letter, I would appreciate it if the doc filed an appeal for me, and either way, I still plan on having the procedure done on Friday. I plan on calling Monday morning, and if I have to leave a message, so be it, I'll say the same thing ...

So, all in all, I guess I'm still having my TAH on May 12th and will find out the time on Thursday ... Now, do I ask my parents if they can help us out or do I attempt the payment plan (which I won't be able to make thousand of dollars of payments a month) and apply for finacial aid? Hmmmm ... Either way, no one will talk me out of this, including my parents ... Can we say I'll be quite the mean one for the next 7 days

I get mad at myslef for making myslef suffer longer by jumping throughthe hoops insurance made me to. I had to try meds, then an ablation , then meds again then finally okayed for hysterectomy by insurance. Docs wanted hysterectomy from beginning as DID I. Plus basically we knew the other trials wouldnt work because I dont actually have a gyn problem It is a blood/clotting disorder. Since then husband changed jobs and our insurance isnt so hot and we had to ask family to help pay, I am also on medicare ( disability)which paid some as well.

I am glad you are going ahead!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

as long as you make payments they cant do anything.. you may show late payments on your credit report ,but you life is worth morethen worring over credit reports.. again ask your doctor to resubmit maybe they can code the order diffrently to the insurance company ,the girls in the office will understand,each insurance company either accepts or denies billing depending on the coding,the doctors office needs to code it more serverly then what the submited,but even if they wont pay for the surgery its your life ,send in what you can afford and be happy again,do not how ever feel guilty for taking care of your self.

Thanks guys I'm so thrilled to have found this site, you all are godsends. I'll be back on later or tomorrow to catch up with everything ... But for now, my husband and I are going to a dinner with our bowling team, and I'm not letting the insurance company ruin our evening. Then I leave Sunday afternoon for Atlantic City. My DH is taking me away to relax and just spend time together alone before the 12th ... I'll be home on the 10th, have the 11th to finish up, and the castle on the 12th ... Will be taking my comp as my friend's father was just diagnosed with cancer and I want to be able to keep tabs with her ... Well, be back later

I needed my hysterectomy and bladder fix last year but dr. said we need to build a "case" for insurance. He knew I needed it too but said was I ready to pay out over $40,000 without insurance help? I went the D&C route, ultrasounds, my doctor took mega notes at my visits to help, went through the urodynamic testing, built my "case" and finally this year he said let's go for it. My first bill from operating room, drugs, anesthesia, doctor was $44,000! Outrageous! Did they use gold plated instruments and pure silk thread to sew me up? Wow, but the hospital had to write off 36,000 because of insurance and I paid $822.00 and insurance paid the rest. Just be prepared if you go without insurance what you may be facing and it sounds like you have already checked into some things. It was alot more than I thought and I haven't gotten my hospital stay bill yet for three days. At the time I was upset I had to wait, but now I'm glad I didn't have to pay that by myself. I was not in pain so much so it worked out for me. I'm not sure what all you are having done but it may not be as much. I hate insurance hoops too!!!!!!! If you are in pain, I agree with the other post, have dr. office change coding to express urgency and maybe have dr. write a letter of appeal. Just a thought. Hope things work out for you.

I just went through the same thing. My surgery wasn't pre-certified until 45 minutes before I walked in the door for my pre-op on the 25th. My Dr. had to write a letter and the nurse and billing office staff also fought on my behalf. After the procedure my DH asked the Dr. if he had to jump through hoops to get the hysterectomy. He said, your wife jumped through all the hoops. I couldn't go on any hormone therapy due to a DVT last year, I tried an HTA and it failed in 2 months. I waited 6 months after the failure before I finally went to see my Dr. The billing girls even said they asked if I had done floor excercises!! Get out. Dh said if they hadn't precerted me he would have gone to the bank and self paid. Remember to when you self pay a lot of places will give a discount. As if going through surgery isn't stressfull enough, the insurance companies have to insult you by thinking you just jumped the gun to do it. in there and keep fighting till the bitter end. Keep on your Dr's office to, they can put the pressure on. Here's a big for you!

I also hate insurance companies, the endless phone wait, some people who just don't know what they are doing. I know how you feel. You are going to have to fight for this. My hyst,a sah was uncomplicated, I had the surgery on Wednesday and was out of the hospital Friday morning. I was shocked by how much the whole thing cost. The hospital stay and surgical room costs were $29,500. The surgeon, assistant surgeon, and anesthesiogist's costs came to another $10,000. Add another $5,000 for some after care visits (I had to have more because my incision opened up). It really adds up!!
In my case I waited until surgery was no longer optional. A cat scan showed my uterus had displaced my intestines and was pressing on my bladder. My dr had a good case. My gasteroenterologist told me that I needed to do something about it.
I would want to know exactly why insurance denied coverage and when you talk to the insurance rep, be sure to get their name and phone extension. Document everything. If your doctor needs more tests to show that your surgery is necessary, get them.
I wish you luck. I hope you can get everything you need to hassle with done before your surgery as you don't want to be worrying about this after. Maybe your dh, a family member, or close friend can help you in dealing with the insurance-the less stress, the better. Hugs.

Just a hint--before signing any payment agreements read the fine print. Once the agreement is signed youre stuck with the terms, no questions asked. The same applies to using the hospitals financial aid---carefully check the interest rate as some hospital's are quite high (my best friend did this when she had an emergency hospitalization without insurance.the interest rate was over 15%).

Like someone else mentioned, if at all possible try to pay cash since most hospitals, if not all, offer significant reductions in their fees.

Good luck
diana

Tenley,

I think you should wait and work with the Dr's and your insurance company before you have your surgery. The cost can be 10's of thousands of dollars, and that is if everything goes well. If there is a problem it is not uncommon to hear of medical bills reaching the 100's of thousands.

Regardless of what is commonly thought, not paying your medical bills, escpecially if you sign an agreement saying that you will pay them, can hurt you. It is also not true that any amount, no matter how small is enough to prevent them from taking you to court. There is also a substantial amount of "bill collecting" that you would have to endure.

Please reconsider. Call the insurance company back. Ask them what is missing to get your surgery approved.

Talk to the Dr's office. See what they can do. They usually have lots of experience with these types of situations.

If it were me, I would rather postpone my surgery until all was in order. I would not want to set myself up for years of problems.


S,
Kay

I am so sory you are having this problem now. I do hope everything will work out. Just remember no matter the results with insurance, your health is worth it!
I have been self employed for years and have not had insurance. My husband has VA benifits but I have nothing. We were young and if we needed a dr, which was rare, we paid far less for the dr than for the insurance premium.
WELL... then on 4/3 I started having severe pain in my lower back which moved to the front. I assumed it was a kidney stone so I waited. On 4/4 the pain was excruciating. I went to a dr who ruled out stones, did a pelvic, felt a mass. So here is my breakdown:
4/4 - Dr exam & pain pills = $180
4/5 - Ultrasound = $1,300
4/5 - CatScan = $3,600
4/6 - GYN = $2,500 (included physicians surgery fee)
4/7 - Hospital stay & OR costs = $15,000
4/7 - Lab fees for blood and pathology = $1,500
4/7 - Anestisiologist = $1,200
These are rounded but still alot of money.
The anestisiologist gave us a 25% break for cash in 30 days and the hospital gave us 20% for full payment.
That helped and THANK GOD we were in a position to pay it all! Not much left but compared to the alternative which in my case was fatal, I'll take it!
My husband thought I might not make it and quite frankly so did I.
I have been on both sides financially and while I prefer not to have debt, I much prefer my health and my life.
I say do what you can as far as the debt and do EVERYTHING possible as far as your health!