You will simply NOT believe this

I ran by the post office at lunch to mail some letters and decided to check my box, I usually just check it on Saturday. I got some junk and a letter with no return name on the address, just an address. I'm thinking bill, so I open it to see what it is. From my Insurance company.

Dated 2/28/06
Telling me that they had reviewed my request from 1/18/06 for TAH, and that after reviewing the information provided (my scathing letters and the letter from the doctor on appeal) they have determined the services I requested will be covered....

ON 3/1/06 I had my LAP and Hysteroscopy. I didn't have to have them done after all...after the fact.

I can't tell you how irritated I am at this point. BUT...on a happy note, my out of pocket is 1500.00 and my cost for the Lap on 3/1/06 is 1680.00...so my hysterectomy is going to be totally 100% covered.

How's that for justice?

just had to share.
T

I'm so sorry you had to have the LAP & Hysteroscopy done for naught. That's what I'm afraid will end up happening to me! I can't believe you had it done after they mailed you the letter. jeeeshhhh....

As you said - the good news is that the hysterectomy will be covered 100%. I wish these guys could get their act together! Not only did their delay cost them more money, but you had to have procedures that weren't necessary.

As I said on my insurance rejected thread - I'm still waiting to hear what the ins. co. says after my doctors phone call. I called them yesterday, but the lady said it would be better for my doctor to contact them for an appeal. I called my doctors office a few hours ago and the sweet lady who schedules these things said she would put it in front of her this afternoon. Crossing my fingers that they say yes today so I can quit worrying.

Congrats to you T.

I have a strong sense of justice, and I believe that we have to stand up for ourselves. I took my benefits counselor out of the loop because she didn't necessarily have my best interests at heart. My file was one of 150 she had on her desk, and she had no answers for me. I am not afraid to go the top dog if that is what it takes to get someone to listen to me. I figure I pay my premiums, each pay period, I don't abuse my coverage and when it comes to my body, my quality of life, no one tells me what I need, except me, and my doctor.

I called my dr. regarding the appeal, she drafted a letter, I wrote one and faxed them both over to the insurance company. I called every other day for a month..and wrote a second very to the point letter.

I asked them if their water hose broke, would they fix it with duct tape, or would they fix it right, and get a new hose installed? I asked them if their child cut their knee open, and it needed stitches, would they simply put a bandaid on it? I told them I had the right to a treatment that would FIX my problem, that nothing else will guarantee a fix except a Hysterectomy.

You have a right to be involved in this process. I wish you the best and I hope things turn out for you and that you win this fight.

Keep us informed
T