insuance says no !!!

Dr. says i should have hyster and i agree he says i have poly cyst I have all the symtons like weight gain, hair growth,heavy bleeding,high bp .insurance says i havent tried enough treatments but i have taken every pill i think they make and nothing has worked .also got sec. opinun and he agrees so were trying insurance one more time .any advice you could give would help . THANKS IM NOT VERY GOOD AT THIS COMPTUER STUFF STILL LEARNING HOW TO TYPE. also tired all the time also had these prop.for about 5yrs.

I don't have any experience in this area, but I'd be sure the dr. has thoroughly listed all the treatments you have tried. I know that when my fibroids were first diagnosed, my gyn said they may eventually lead to a hyst., and that we'd have to go through some "formalities" like "wathcful waiting" (been there, done that) and birth control pills--these were the most conservative methods to control the heavy bleeding. I told her I'd been on the pill years ago and got migraines, nevertheless she said insurance would demand to see what I'd done to try to avoid the hyst. So, she gave me a perscription, I took 3, called her and said I didn't like them, and she said "good enough, you tried them, didn't like the side effects, we haven't lied".

I realize you have to play the game, but maybe your records need to go into greater detail about your discomfort and what you've tried.

I'm sure other ladies have other suggestions and have been through it.

I'm not even sure my hyst. will be approved, I'm scheduled for 12/26 but don't know what insurance will say yet.

Good luck to you.

I had to go through some hoops to get approval for the hysteroscopy/D&C. The insurance wanted me to take Bp first and the doctor then pointed out that I was taken off birth control pills because of urinary frequency/bladder side effects. That was enough to make the insurer happy. I have not yet submitted for approval for the TVH-- long story, now looking for another doctor to do the procedure.

I just wanted to say I agree with documentation on what happened with each method of treatment. Good luck.

Sharon

When I first went to the gyn with pain, he thought I had endo. He wouldn't do any treatment until he did a laparoscopy. He found out through that that I had a large fibroid pressing on my back. He "offered" options...live with it or take it out. I had already decided I was having a hysterectomy, so he jumped through whatever hoops were necessary and my hysterectomy is scheduled for Oct. 26th.

The other insurance snag that came up was I got preapproval for TWO days in the hosital after my surgery. When I mentioned it to my dr. at the preop, he said not to worry that after two days his office calls the insurance company and gets an extention. IF they don't choose to be cooperative with the extension, then my dr. leaves the thing that they use to administer meds (codiene) for an extra 24 hours and the problem is taken care of.

Good luck!!!

I have been battling insurance company for 4 years to get hyster. Finally approved and got it on 10/11.
I had to have numerous D & E's, hysteroscopy, laperoscopies (3), was on progesterine, birth control, deprovera, etc. All where a waste of time,not to mention IMO a risk each time I had to have surgery. Second opinion Dr. made it even tougher cuz he was conservative and since I am only 35 he suggested I "tough it out" another 10 years (yeah right!) He wanted me to go for endometrial ablation, I told em all to go to H*LL, no more surgeries, I want Hysterectomy.
Insurance Company once again denied it, I appealed it. Got all records from the DR. with dates of surgeries and other treatment methods I have had, complete with results from each. I actually hired an attorney to present all this stuff to the insurance company, and threatened to sue, because they put me through several unsuccessful surgeries (to meet their criteria)and for mental anguish because my periods were actually affecting my mental status each month I had to endure them. Within one week, they approved the surgery.
I have a g/f that had fibroids removed 2X before they would approve a hyster. and she had to fight for that (she was in her 40's). She just appealed, no attorney, and won.
You may have to fight them for this. But it is something worth fighting for. Call them and ask what their procedure is to appeal it. Arm yourself with all your personal medical information.
Good luck!

I had several go-rounds with our Ins. Co. and finally husband called the Insurance Comissioners Office. They gave him some advice on how to deal with it and I believe made a phone call and it was approved within a few hours.
If you have tried it all and have a second opinion I would not let the Ins. Co. bully you! Call your Insurance Comissioners office and see what they can do for you! There is no reason you should have to suffer just because of red tape with the Ins. Co. Grrrr I hate Insurance Companies.

I also had problems with insurance. My doctor wanted to do a hysteroscopy/D&C to try to alleviate some of my constant bleeding and pain. Insurance said NO, that we had to try "non-invasive" procedures first. Which meant that I had to try BCP's for 3 months. We tried fighting the insurance, but to no avail. My doctor tried, I called, my DH called, and DH even had his employer call, but NOPE they would NOT budge. So I know how you are feeling. Finally I had no choice but to try the BCP for 3 months. It did absolutely NOTHING to help with my problems. Actually it made the bleeding and the pain even WORSE. Then my doctor sent all the documentation and they approved the hysteroscopy/D&C with no problem. After the results from pathology from the hysteroscopy/D&C, hysterectomy was suggested and I had no problems getting that approved either.

I agree with the other ladies. Have your doctor send them detailed documentation of exactly everything that you have tried. That should give them enough proof that you have tried other means of treatment and that nothing has worked.

I wish you the best of luck.

With managed care the primary option as far as insurance is concerned, patients have to suffer needlessly and sometimes even die to get the survices you and your doctor know you need. Instead of paying for the hysterectomy outright, they actually end up spending more because they then also have to pay for all the "other" stuff you have to do to prove you actually need the surgery. I personally think it is recidulous that we have to suffer at their expense (no pun intended). I don't mean to male bash, but in most cases the people telling us to just put up with it a few more years are men and have no concept of the pain we are going through.

OK--off my soap box. Sorry if this sounds like preaching. I realize I would be preaching to the choir anyway. Just wanted to get it off my chest.

just read the post from cockerspaniel, ya know i really ****** my doc off when i told him that he was being "insentive". that if he was having to go through the severe bleeding, the cramping, the exhaustion, etc. he would not be delaying anything. (i was right, but it still upset him). he got over that, mainly because i insisted on surgery. hell hath no fury like a pre-menopausal woman. there is strength in hormonal imbalance.

Thaks to everyone that posted at least I know im not alone .It also seems like when insurance said no everyone said maybe you really dont need one then you really start feeling more maybe you dont but I know it has to be done dont know what else to do but wait and see.THANKS AGAIN EVERYONE.