Insurance denied hysterectomy

I can't believe this. First my hysterectomy was postponed in January to March 21 because I was anemic. I found out 3 days before. This time I got the okay everything is set and I get a call from gyn's office saying that my insurance is denying the surgery and won't tell them why. Their dr. has to talk to my dr. So I call and they try to give me the brush off saying we sent a letter in the mail. I told them the surgery is on Thursday, I have already taken time off from work, arranged everything, and I am in a lot of pain, I want to know now.

They put me on hold forever and come back with because I didn't have a pap smear. Really, that is the reason?! I explained to them why I have never had a pap smear and what difference does it make if I am having a total hysterectomy? When I had emergency surgery 8 years ago, the doctor was expecting and ready to do a full hysterectomy and I didn't have a pap smear. Thankfully he just took my ovary and a huge cyst.

So they are refusing to talk to my dr.'s office. They will only talk to my dr. who was out today. So now I am stuck waiting for the call tomorrow to see if it is cancelled or not.

Sorry to vent, but I am so frustrated.

Honestly!! I am so sick of reading these stories! We make our payments every month. We believe we have a plan that is fair and will cover us when we need it. Do these insurance companies seriously think we WANT to have this surgery? That we want to undergo anestheisia, pain and weeks of recovery? And they give you a crazy reason like that? My insurance would not pay for a mammogram for years because the state of GA did not require insurance companies to cover it and it was considered "preventative" under my plan. So they would pay hundreds of thousands for chemo or mastectomy but not $200 for a mammogram? The law finally got changed with Obamacare where they are now required to cover it, but how many women suffered and died because they could not afford a mammogram. I think Hystersisters needs to take this up as a cause! Hysterectomies are NOT elective surgeries.. There should be minimum requirements to get one approved, not maximum. It should be automatically approved after a certain age. We should not have to jump through hoops. Can you say STAND UP FOR A CAUSE??

Oh no! I am so sorry you have to go through all this. I have a feeling everything will work out soon, though. Insurance companies like to question things. However, I don't blame you for freaking out. I would be too! All the planning and anxiety leading up to major surgery, just to have it possibly postponed, is enough to put anyone over the edge. *hugs*

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Originally Posted by 4leena I can't believe this. First my hysterectomy was postponed in January to March 21 because I was anemic. I found out 3 days before. This time I got the okay everything is set and I get a call from gyn's office saying that my insurance is denying the surgery and won't tell them why. Their dr. has to talk to my dr. So I call and they try to give me the brush off saying we sent a letter in the mail. I told them the surgery is on Thursday, I have already taken time off from work, arranged everything, and I am in a lot of pain, I want to know now. They put me on hold forever and come back with because I didn't have a pap smear. Really, that is the reason?! I explained to them why I have never had a pap smear and what difference does it make if I am having a total hysterectomy? When I had emergency surgery 8 years ago, the doctor was expecting and ready to do a full hysterectomy and I didn't have a pap smear. Thankfully he just took my ovary and a huge cyst. So they are refusing to talk to my dr.'s office. They will only talk to my dr. who was out today. So now I am stuck waiting for the call tomorrow to see if it is cancelled or not. Sorry to vent, but I am so frustrated.

Omg! That is unbelievable!!!!!!!! I agree with Newin. These insurance companies act like a hysterectomy is a 'glorified tummy tuck'!

There was another lady here a while ago with the same story. So her Dr did the pap and things moved along. I hope this can be easily settled, I'm sure it's maddening to come down to the wire. No idea why they didn't decide this earlier, or why the Dr didn't pursue the preauth sooner, so you could plan. Good luck getting it fixed tomorrow.

Thanks everyone for the kind words. I am just hoping for the best. Unfortuanetly I am not sure if I can have a pap smear done. I have never had a pelvic exam at all. I am a virgin and don't think I could mentally handle it because I would feel it as a violation not to mention the pain. I know women have it done all the time and don't think anything of it. However it would be extremly difficult for me to have one. Even if I do get up the courage I don't know if it would be done in time for Thursday. This is the second time I would have had it postponed days beforehand.

I think it took so long for them to deny because I have a very complicated medical history and there were a lot of notes. Dr.'s office said it was stated in the notes the reasons whyI never had it done, but being so many I am wondering if they read them all.

This is just awful! If they continue to deny you find out how you can appeal. Is there someone in your doctor's office that works with them directly that can help you? If not, then find out what you need to do and get ready to do battle sister! It sounds like you are going to need to advocate for yourself here. You can do it!

As for the pap smear, they aren't painful, just strange and awkward. If you need to get one in order to have your surgery well, you will be able to handle it. Hang in there. Get ready to put on your armor and do battle if necessary!

The issue may not be because you never had a PAP. The issue may be because you never had a pelvic exam. There are things the doctor can diagnose during this exam.

Have you had an MRI, CT, or ultra sound to come to the conclusion you need a hysterectomy?

Believe me I am NOT on the side of the insurance company. I just find it odd to undergo a hysterectomy without a pelvic exam. I would think one was done when you were under anethesia for your last surgery?

I had several abdominal ultrasounds and a couple of cat scans. I have never had a pelvic exam. My dr. was going to do one when I was under right before the surgery (which is still difficult for me to accept, but at least I won't be aware during although mentally it will continue to bother me) . According to what my insurance company told me, the pap smear is the issue.

I could never have a pap smear because I view it as being violated. I have seen them done in person and have friends who were in the same position as me who regretted it because of the pain and mental anguish. Espcecially because it is uncalled for, for someone in my postition. That's why my dr. never insisted.

My insurance won't even talk to anyone at my dr.'s office except for my dr.

If it is required to have a pap, then I won't be having the surgery. I'll just have to live with my 18 week uterus and hope it doesn't get bigger.

Hi 4leena,

Petrified raised a valid question with regard to you having a pelvic exam. I have 3 female relatives who are virgins and though they've never had a pap smear before, they were able to get their procedures done so long as the Dr. forwarded clinical paperwork showing that they had an ultrasound along with a pelvic exam.