I need some advice Big Time please - surgery approval w/Medicaid? ~ Update!

Hi ladies,
I was supposed to have a Total hyst, taking the cervix, uterus and both ovaries on April 11th but I keep getting red taped by medicaid here in Texas. I really need this done. I am in pain all the time from cysts ranging in size from small to golf ball sized wich are clustered all over on both ovaries. I've already had cervical cancer, my great-grandmother died of ovarian cancer which came about from cysts on her ovaries, I had a really thick lineing on my uterus (which was taken care of today with a D & C surgery) and fluid around my ovaries. I am in pain every day and it just gets worse every day. My doctor has done all he can and so have my nurses but medicaid is just being difficult saying I don't have enough cause for a hyst. They only way they would pay for this hyst is if it were an emergency hyst. My doctor is hoping that what was taken out from doing the D & C will show just cause for the hyst, even though I have enough just cause as it is right now. They have never had this much trouble getting a hyst approved but they are with me for some reason. Have any of you ladies had this problem and were you able to bypass the red tape some how? I could really use some advice on what to do. It is so stressful, depressing and painful cause I need it done. Thank you for listening and I will be looking forward to some help and or advice concerning this. Have a Blessed rest of your day!

Gina

Hi Gina...sorry to hear all the trouble you are having to get a hyst...I just want you to know that you will be in my prayers....I know this does not help ....
sending s

So sorry you are going through this.I have never had this happen to me.Have you gotten a second opinion.Maybe this would help to have another dr on your side.Just a thought.Good luck and let us know how it turns out.

Thank you Amric and Tread! I really appriciate the prayers and thoughts. I was going to get a second opinion (or as many as I could get) but medicaid won't pay for second opinions - I guess cause they don't want to be proved wrong. I also went to the ER one night cause I was in so much pain but the ER doctor that was there was AWEFUL! He was the biggest jerk I have ever incountered in my life! I am highly thinking that come Monday, I may call the ER to see if there is a female doctor in that may be more sympothetic to what I am going through and call for an emergency hyst so that it will get taken care of. My doctor is a male doctor but I love him to death, he is Nothing like the jerk of a doctor in the ER the other night. Any way, thank you ladies!

Gina

I'm guessing it is getting more difficult to get Medicaid and other insurance companies to pay for "elective" hysterectomies because of all the new research results regarding the long term effects of hysterectomy. In the last year or two it has been determined that most hysterectomies are unnecessary and the AMA and FACOG have called upon doctors to re-evaluate the necessity of hysterectomy and to make sure they have exhausted all other treatments before resorting to surgery. They are probably safeguarding themselves against the onslaught of lawsuits that are bound to be coming up as more information from the studies reaches the public.

For many, this could be a good thing, and even though it's making your life difficult now, maybe understanding the cause can help you deal with the frustration and delay.

However, I am under the impression that it is illegal for them to deny you a second opinion when surgery has been recommended. Therefore, the very reason they may be denying you your case (fear of litigation?) may be your ace in the hole if they are, indeed, legally bound to provide you with a second opinion.

I don't know, and I'm certainly not a lawyer, but I've heard so many stories from other women. Is there a free clinic you can consult with? Often states have free clinics that not only provide medical advice, but they also have legal advice. Ask them what your rights are regarding refusal to grant second opinions.

Your actual diagnosis might be a factor too. Is your doctor calling your condition polycystic ovary syndrome? You probably already know this, but it's normal for women to have cyst on their ovaries. As a matter of fact, every month a cyst is produced and it's "rupture" is what propels the egg from the ovary. Of course, sometimes this system goes a bit haywire and we get a surplus of painful cysts. (As you well know!) I don't think this is what causes ovarian cancer, so that may be why they are not considering your grandmother's history in evaluating yours.

While you are waiting, maybe you can try another tactic with Medicaid- approach from another angle . . . ask for an appointment with an endocrinologist. (Your doctor might even help you with this approach.) If you get approval, try to see a reproductive endocrinologist. This kind of doctor is both a gyn and endocrinologist and might be able to help you with the pain from the cyst while all of you work out the details together. This is kind of a sneaky way to get a second opinion and, if he/she agrees, support for your current doctor's case.

Good luck with all this red tape.

Well, I am on the equivalent of medicaid here in AZ and have had no problem. Are you disabled and on medicare too? They pay for second opinions and I think medicaid does too. You should look up medicaid online and see what their rules are and fight for what you believe in. Don't give in. That's what government offices want you to do. They want you to give up or die.

I was on medicaid when I lived in Ky and they had nothing against people seeking second opinions. If I find you a website on medicaid I will post it for you.

Here is a link for you:

http://www.hhsc.state.tx.us/Medicaid/index.html

Hello Natural Essence

Sorry to hear of your problems w/medicaid. These ladies have given some good advice. Check out the link that smilinfaces gave you. Hope things start going your way.

and

You might also check to see if they'd approve an oophromectomy (however you spell it--removal of the ovaries only), if that were an option to treat what you have. Good luck.

I am sorry to hear about your issue with medicaid I am too on something like medicaid and they weren't going to pay for mine either until I had proof of my diagnosis. First my gyno sent sent me to get an ultrasound that didn't do anything she then sent me to get an MRI which gave them proof of my diagnosis before they would pay for it now they will what is funny though is that they are paying for all these tests when they could just do it and get it over with. Maybe you could either go to the top person of medicaid and talk to them and be firm with them or maybe you could switch docs through medicaids ok that knows the loops to get through. Sometimes it takes a certain Doc that knows how to word things that could get the approval. Good Luck. Hope this helps.