HysterSisters Hysterectomy Support and Information
HysterSisters Hysterectomy Support Tutorial

Go Back   Hysterectomy HysterSisters > Hysterectomy Special Needs > Endometriosis Support

HysterSisters answers for your Hysterectomy Questions With free registration, you can ask and answer questions in our HYSTERECTOMY forum community, get free booklets, access Hysterectomy Checkpoints and more. You are not alone. The HysterSisters are here for you. Join us today!

Reply

Insurance will pay for hysterectomy, but not the robotic surgery for endo excision! Insurance will pay for hysterectomy, but not the robotic surgery for endo excision!

Thread Tools
  #1  
Unread 07-26-2011, 02:53 PM
Insurance will pay for hysterectomy, but not the robotic surgery for endo excision!

I've spent the day venting, so I'm not posting to do more of that. But I am curious if anyone has run into this? The crappy insurance I have feels it's more logical to pay for a hysterectomy at the age of 34 and the years of replacement hormones I was told it would come with, but not the surgery that will excise the endo-the one most likely to relieve the pain.

The Dr said he will drop the price from $15,000 to $5,000-which is huge on his part-but still steals my breath a bit.

I asked the doctor's assistant if she thought a good logical break down of costs in a letter to the insurance company would help but she said it's a dead end.
  #2  
Unread 07-26-2011, 07:33 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Did you speak to anyone at your insurance company? You probably need to rise up the ladder, ask to speak to supervisors and get really insistent! I don't have experience with surgery but work in rehab and know it can work to fight for more physical therapy approval.
  #3  
Unread 07-26-2011, 07:47 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

The docs assistant said they have pushed the issue multiple times and gotten nowhere. It's disheartening to think the surgeon has tried to convince them and failed. But I will give it a try-estrogen patch is supposed to be pretty expensive so if hysterectomy alone isn't more expensive, certainly the years of estrogen must be?

I'm waiting for the hospital to get back to me to tell me what their charges will be, so when I call the insurance company I can also ask if they will still be covering those charges.
  #4  
Unread 07-26-2011, 08:56 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Insurance is the worst part of my job- and my endo journey! My patients often have better luck than I as a therapst do fighting for individual approval, so it is worth a shot. See if you can break down the prices of even one year of hormones vs a surgery for some ammo if it works in your favor.
  #5  
Unread 07-26-2011, 09:15 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Thanks so much. From calling the 800 number on my card, how many levels away do you think I will be from a person that can make decisions? Ive never succeeded in getting an insurance company to change their mind on anything before.
  #6  
Unread 07-26-2011, 09:22 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio



Another idea. When I appealed, I worked with the client customer specialist at the insurance agent's office. It was that person's job to try to be the liaison between the patient and the insurance company. For one, if too many patients fuss, the employer of those patients might switch insurance companies and agents.

Both times I appealed with two different insurance companies and two different insurance agent's, the customer service specialist for each off was invaluable. I always appealed in writing and it was the customer service specialist who knew where to send the appeal.

One thing they had me include was a lot of detail about my situation and precisely what I needed done for my situation. Someone in the surgeon's office might be able to help as well.

In my case--and I am not necessarily advising you to do it this way--I had the surgery and then appealed. I had weighed my pros and cons and decided if I got stuck with the entire bill it was worth it.

My surgeon did work with a facility, anesthesiologist, and pathologist who were covered as in network so the only fees on the line were for the surgeon. I am not sure how it would work for you though--my surgery with a specialist was post hyst so there was no question about hyst vs excision--but as (((VitoTheColon))) mentioned, it is worth a shot!

Oh, the da Vinci site also has some help about insurance coverage, but I think it is more to have a hysterectomy with the da Vinci vs. an alternative hysterectomy type. But, they might have some ideas, too, since part of their company goal is surgery with their equipment.

And to answer your last question--you could be 101 people away from who you need! Think of when you call Tech Support. That first layer of people are the bottom of the line and sometimes their job literally is nothing more than being a glorified answering machine. That sounds a bit harsh but my point is that if you can't get beyond the person who answered the call, you aren't likely to get any where. You need at least a supervisor who can make decisions.

  #7  
Unread 07-26-2011, 10:07 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Just a thought- is your insurance through an employer? If so, is there an HR person at your employer who could go to bat for you? I know the HR person where I work takes great ownership in the insurance benefits she negotiates for us and wants to know if there are challenges.

I was very fortunate to pay much less then I had anticipated so I called to thank her for the great coverage. Though she always welcomes calls, she was thrilled to hear good news as she usually only hears about the challenges.
  #8  
Unread 07-26-2011, 10:57 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Unfortunately, I currently have state insurance. It's a bit of a miracle that the specialist takes it at all. The differences between having private versus state, as far as I've experienced, are the differences in being the "borrowed ladder" or the genetic star in Gattica. It's crazy.

The insurance company didn't specify "we will pay for this but not the other" there were just no issues with the hysterectomy-or with anything ever so far. This particular surgery is the first time I've run into a refusal for coverage. So first I have to point it out to them and I'm hoping that I can get to that one person, with decision making power, will look at it all and see the oversight.

I'll check the Da Vinci site and see what I can find, thanks.

Thank you, I'll let you know if I have any success.
  #9  
Unread 07-27-2011, 08:35 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Another thought from reading a Pre Op thread. Has your doctor actually tried to ask for a "Peer to Peer" review? Meaning your doctor actually speaks to the insurance company's doctor who makes decisions?

Just a thought!

  #10  
Unread 07-27-2011, 08:54 PM
Re: Insurance will pay for hysterectomy, but not the robotic surgery for endo excisio

Good thought, Weiser!! Sometimes state insurance can really drag their feet, stay on them and always get a name and confirmation number when you talk to anyone. And know that the grass is not always greener, private insurance can be just as difficult depending on the plan.
Reply

HysterSisters Free Hysterectomy Booklet
What 350,000 Women Know About Hysterectomy with 50 pages of information, helpful tips and hints as you prepare and recover from hysterectomy through an organized timeline.




Thread Tools

Forum Jump

Similar Threads
From This Forum From Other Forums
5 Replies, Last Reply 06-28-2011, Started By ajb05
3 Replies, Last Reply 04-09-2011, Started By lisabelle
3 Replies, Last Reply 12-01-2010, Started By bajntime
2 Replies, Last Reply 09-14-2010, Started By HarmonyKey
3 Replies, Last Reply 06-08-2010, Started By january2700
3 Replies, Last Reply 04-27-2010, Started By staff
4 Replies, Last Reply 08-11-2009, Started By fred1
2 Replies, Last Reply 03-02-2009, Started By psycg1rl
3 Replies, Last Reply 10-21-2008, Started By thatcher
2 Replies, Last Reply 06-19-2008, Started By chiphauger
2 Replies, Preparing for Hysterectomy (pre hysterectomy)
5 Replies, Hysterectomy Recovery (post hysterectomy)
0 Reply, Hysterectomy Recovery (post hysterectomy)
2 Replies, Preparing for Hysterectomy (pre hysterectomy)
1 Reply, Hysterectomy Options and Alternatives
3 Replies, Pelvic Floor and Bladder Issues
10 Replies, Hysterectomy Recovery (post hysterectomy)
2 Replies, Hysterectomy Recovery (post hysterectomy)
1 Reply, Hysterectomy Recovery (post hysterectomy)
0 Reply, Laparoscopic Hysterectomy Stories


Hysterectomy News

November 27,2014

CURRENT NEWS

Dryness And Menopause - November Checking-In Newsletter
Have you noticed problems with dryness? Dry skin maybe? What about dry eyes? Read on for some great tips and ideas for a ... News Archive

TODAY'S EVENTS

Calendar - Hysterectomies - Birthdays


I am a HysterSister

HYSTERECTOMY STORIES

Featured Story - All Stories - Share Yours

FOLLOW US


Your Hysterectomy Date


CUSTOMIZE Your Browsing  


Advertisement


Featured Videos

Dr. Arnie Advincula answers questions about endometrios...

Dr. Arnie Advincula answers questions about endometrios...

Dr. Arnie Advincula answers questions about endometrios...

Dr. Arnie Advincula answers questions about endometrios...

HysterSisters App Store Android app on Google Play


Advertisement