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Frustrated and Sad..need encouragement
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10-19-2006, 12:08 PM
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Guest
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Posts: 38
Hysterectomy: November 13th, 2006
Surgery Type: TVH
Ovaries: Kept 1 or both
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Frustrated and Sad..need encouragement
A little history. Severe periods that last months,cramps etc. (since I was 12...first period lasted 3months) Endometriosis, enlarged uterous.
I was scheduled for a hysterectomy in december. Because I've had a period for the last 8 weeks they tried hormone therapy to stop my period. Stopped it for 2 days and then started again. The hormones make me severely nauseous and give me headaches. Plus, the possible stroke and heart side effects scare me to death (I already have a mitral heart valve leak).... So my doctor scheduled the surgery for first week of November. I got my hopes up. Couldn't even dream about what it would be like to have this nightmare bleeding over with... then... My insurance denied the pre-authorization. Denied. No hysterectomy. They want me to have a DNC. So now I have my insurance company telling my doctor what kind of medical procedure I need. Has any one else had this problem? Has anyone had to have a DNC? Any success stories there???? Cuz I'm frustrated and sad and PMsY... I've called my insurance company up three times today to vent (sorry poor lady who keeps answering my call)...ARGGGGGG!!!!... I told her to tell the man who turned down my surgery request and answered it with "have a DNC first" ... to bend over and let me give him a DNC...see how he likes it. Need encouraging words please... before I call that poor lady at the insurance company again.
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10-19-2006, 12:21 PM
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HysterSister
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Posts: 247
Hysterectomy:
Surgery Type: TAH
Ovaries: Removed both
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Frustrated and Sad..need encouragement
Honey, APPEAL the decision.
The man that went to medical school recommended a hysterectomy, whose expertise is more important?
Someone on the appeal committee will be a female and they will know what they are asking you to do is stupid.
You should NOT end up with two procedures and we all know that is what is probably going to happen.
Let them know it doesn't make good fiscal sense at this point for them to pay for two operations, etc.
(((HUGS)))
This isn't fair, and I hope you get it straightened out with them. We pay premiums to get quality care not "good enough" care.
Let me know what happens, okay?
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10-19-2006, 12:23 PM
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HysterSister
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Posts: 126
Hysterectomy: October 5th, 2006
Surgery Type: TAH
Ovaries: Kept 1 or both
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Frustrated and Sad..need encouragement
I have no stories to share, other than to keep on your doctor to insist to the insurance company that the hysterectomy is what is in your best interest. Call it a "life saving procedure" or code it differently. My doc was great in presenting it to the insurance company in such a way as to obtain pre-authorization.
STICK WITH IT - the squeaky wheel gets the grease, so they say.
Best of luck. I had to struggle for 18 years with the bleeding problems. I was on the pill for 16 of them.
I'll be thinking of you.
Mellybug
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10-19-2006, 12:32 PM
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Guest
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Posts: 38
Hysterectomy: November 13th, 2006
Surgery Type: TVH
Ovaries: Kept 1 or both
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Frustrated and Sad..need encouragement
Thankyou...for the encouraging words. Ever have one of those days where you have to talk yourself our of crying (of course you have).... today is one of those days.
My doctor is going to call and talk to them personally and appeal the decision. He says that a D&C is not going to help and its going to cause me unneeded pain, time off work and yes more expense. Its ridiculous. I just had my hopes up for the surgery in November.
My boss at work said that if they don't approve the surgery he is going to call them himself... apparantly the hormones I'm taking aren't making anyone happy.
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10-19-2006, 12:42 PM
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HysterSister
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Posts: 247
Hysterectomy:
Surgery Type: TAH
Ovaries: Removed both
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Frustrated and Sad..need encouragement
Hang in there.
It's sounds like you have lots of people on your side.
Don't worry, it may be November yet.
Keep us all posted.
(((HUGS)))
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10-19-2006, 12:50 PM
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HysterSister
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Posts: 1,535
Hysterectomy: July 31st, 2006
Surgery Type: SAH
Ovaries: Kept 1 or both
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Frustrated and Sad..need encouragement
Sorry you're sad and frustrated. It isn't easy dealing with insurance cos.
I had a D&C before my hysterectomy for heavy bleeding. It did help but I had fibroids and my GYN was able to remove the trouble maker fibroid causing the bleeding. They came back but it bought me a few years.
It truly amazes me how a dope (sorry ins people ) from an insurance company can tell a Medical DR how to treat his/her patients.
My hyster was first denied b/c my DR's office didn't respond fast enough for my insurance company!
I told my insurance company that they were a pain in the butt! She didn't like hearing that but too bad.
It is so upsetting to be contemplating having surgery and then have trouble with your insurance co. Just not fair!!
Wish you lots of luck. Hope all works out for you. Your DR office should do the fighting for you . . .they are used to these knuckle head insurance cos!!
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10-19-2006, 12:50 PM
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Guest
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Posts: 379
Hysterectomy: September 29th, 2006
Ovaries: Kept 1 or both
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Frustrated and Sad..need encouragement
I knew I would need a hysterectomy but I had a D&C on doc's recommendation to buy some time. Well it didn't even do that. Didn't do a darn thing.
It's very impressive though that both your doctor and your employer are willing to fight your insurance company on your behalf.
Jeez. Can you just skip the D&C but SAY you had it and it didn't work?
Bleeping beurocrats.
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10-19-2006, 01:13 PM
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Guest
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Posts: 38
Hysterectomy: November 13th, 2006
Surgery Type: TVH
Ovaries: Kept 1 or both
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Frustrated and Sad..need encouragement
The insurance company won't let me talk to the so called insurance 'doctor' who denied the surgery. Only my doctors office can talk to them. I'm sure its because he doesn't want to hear from a woman who has been bleeding severely for over 2months, is now nauseated from the hormones she's being forced to take and doesn't want to just 'buy a little time' with a D&C. (Oh how I'd love to spend an hour with the person who denied this surgery...boy would they get an ear full). I just got off the phone with my husbands human rescource department (the insurance is through them)... and they are going to contact the bleep bleep insurance company and find out what the problem is... my question and theres too... how can an insurance company basically force a patient into a surgery that is not recommended by her doctor in order to get the surgery that is. Kind of Frankensteinish I think. I think I'll go throw a plate against the wall or something. If I had the energy I'd run around the block.
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10-19-2006, 01:28 PM
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HysterSister
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Posts: 247
Hysterectomy:
Surgery Type: TAH
Ovaries: Removed both
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Frustrated and Sad..need encouragement
You are doing the right thing, you are fighting back.
This isn't over yet, and your persistance may win out here.
Punch a pillow, save a plate!
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10-19-2006, 01:35 PM
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Guest
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Posts: 3
Hysterectomy: September 9th, 2006
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Frustrated and Sad..need encouragement
This is my 1st time writing.I hope I'm getting this to the right person-cookiesncream. Hi. I feel for you. I'm recovering from my hysterectomy on Sept.9th 2006. Went pretty well afterwards. I needed a D&C also first,but when DR. went in he couldn't stop bleeding, so the surgery became an emergency. My prayers and thoughts are with you. Stay positive as hard as that may be,it is possible. Aloevera
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