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Medicare coverage for "preventive" hysterectomy?? Medicare coverage for "preventive" hysterectomy??

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  #1  
Unread 10-03-2010, 10:17 AM
Medicare coverage for "preventive" hysterectomy??

I guess I'll find out once the surgeon's and hospital's claims ar filed but I'm just hoping that my case is covered. I've read that "preventive" hysterectomy is not covered by Medicare now (I don't know if there was a policy change) and I'm not sure if my case falls into that category.

I had vaginal bleeding for months,benign polyps were found on an endometrial biopsy, fibroids were seen on an ultrasound, ovaries had been previously removed, and , once the hysterectomy was done, the pathology report found adenomyosis and the fibroids. Usually adenomyosis is found in younger women ( not 70 year-olds) but I had been taking hormone replacement therapy for years and perhaps that contributed to their "activity" and bleeding.

Additionally my mother died of the very rare type of uterine cancer, sarcoma, which cannot be diagnosed ( as with adenomyosis) until after a hysterectomy is done. My paternal grandmother died of endometrial cancer and, incredibly, 3 out of 4 of my grandparents and almost every aunt and uncle on both sides of my family died of cancer. My mother actually three different (primary) cancers, over her life, dying from the uterine cancer. Clearly , there are "cancer genes", though not necessarily of one type, in my family.

So - I'm wondering if Medicare will deny coverage of this hysterectomy, finding it wasn't medically necessary and was "preventive" sugery, which they don't cover. There was no cancer in my uterus at this time. Sometimes I feel I have a "good case" and at others, no.

I did not have a D&C and hysteroscopy before the hysterectomy , feeling that they could well have come back normal and then I'd still be left with a uterus that could "go bad"!
  #2  
Unread 10-03-2010, 12:32 PM
Re: Medicare coverage for "preventive" hysterectomy??

I have no knowledge about Medicare claims or rules, but from what you have described this doesn't sound like preventative to me, it sounds like you were having problems and needed the organ removed! That is, of course, just my opinion. It sounds to me like you've paid your dues just menstrating to the age of 70 for crying out loud! Give a girl a break! Crossing my fingers for you that your bills will be covered.
  #3  
Unread 10-03-2010, 12:59 PM
Re: Medicare coverage for "preventive" hysterectomy??

If the claim comes back and Medicare tries to deny or lessen their coverage - talk to your doctor because there are things the doctor can file back to them to help make sure it is covered. Unless your doc filed it as a "preventative reasons only" I would think it would be covered.
  #4  
Unread 10-03-2010, 01:06 PM
Re: Medicare coverage for "preventive" hysterectomy??

  Quote:
Originally Posted by mahodgman View Post
I have no knowledge about Medicare claims or rules, but from what you have described this doesn't sound like preventative to me, it sounds like you were having problems and needed the organ removed! That is, of course, just my opinion. It sounds to me like you've paid your dues just menstrating to the age of 70 for crying out loud! Give a girl a break! Crossing my fingers for you that your bills will be covered.

mahodgman - Thank you for your kind, encouraging, reply. I wasn't actually menstruating until I was 70 ; my ovaries were removed when I was 65. I would just bleed on and off for an unknown reason ( until the uterus was removed and adenomyosis found that explained it) .

Best to you.
  #5  
Unread 10-03-2010, 07:50 PM
Re: Medicare coverage for "preventive" hysterectomy??

I too had adenomyosis. Glad you got that taken care of.
  #6  
Unread 10-03-2010, 07:57 PM
Re: Medicare coverage for "preventive" hysterectomy??

usually the doctors and hospital check it out before surgery because they want to get paid. Also they can code it as non preventative.
  #7  
Unread 10-03-2010, 08:05 PM
Re: Medicare coverage for "preventive" hysterectomy??

Thank you for your reply. I hope that you are doing well . I'm assuming that your health insurance paid for the hysterectomy and that Medicare will pay for mine. I guess I'm confused as to what is considered a "good enough reason" that justifies the surgery. If the condition is cancer, then of course. But if it isn't and one could live with it, then I don't know if there are denials. I guess I'll find out.
  #8  
Unread 10-03-2010, 08:19 PM
Re: Medicare coverage for "preventive" hysterectomy??

  Quote:
Originally Posted by 70 years old View Post
Thank you for your reply. I hope that you are doing well . I'm assuming that your health insurance paid for the hysterectomy and that Medicare will pay for mine. I guess I'm confused as to what is considered a "good enough reason" that justifies the surgery. If the condition is cancer, then of course. But if it isn't and one could live with it, then I don't know if there are denials. I guess I'll find out.
In my case my insurance approved outpatient laproscopy with possible removal of a mass, when they got in they didn't like what they saw, lots of changes since the ultrasound and changed the surgery to inpatient and everything out en bloc. No malignancy was found, but my insurance paid because of what might have been.

Bleeding in a 70 yr old statistically may to lead to cancer, its not like this was elective surgery.
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