Insurance Concerns..... Please Help!!!!!

Hi guys... My name is Nikki and I'm new here I was just diagnosed with CIN 3 and Adenomyosis. I am currently 24 years old have 2 children and have had my tubes tied for 2 years. My doctor recommended a TAH (they offer di vinci, laproscopic and vaginal methods but the doctor I have choose which also done the D&C with my miscarriage, delivered my last child, and done my tubal does not feel comfortable with anything except old school abdominal. She hesitated offering a hysterectomy due to thinking i would not agree but I had intended on asking for it instead of the LEEP as I am done having kids. I have not tried any other treatments for any of my problems but I am not able to take birth control and due to a tilted uterus it will not hold a IUD so that takes away so of my choices for treatment. I just got insured with <> and was grandfathered into it. It does require a pre-authorization but my doctor seems to think that with 2 problems and not being able to try anything except Lupron for the adenomyosis and HAVING to do a leep or similar procedure for the CIS that they will be more apt to approving it. Has anyone else with <>had any issues of them making them try another treatment first?? I really want the Hysterectomy as I'm scared about the CIN 3 and absolutely tired of the pain and extreme bleeding associated with the other problem... My current periods are 7 days long and using a super plus tampon within 2 hours!!!! I am so weak by the end of the week its scary every month! My doctor has already scheduled everything with the pre op apt July 2 and surgery on July 6! I really don't want to have to wait dealing with insurance as I am going to college and I'm on summer break and if done as scheduled then I would have 6 weeks before school started back. I'm a nervous wreak worrying if they are going to allow me to do this procedure! Please anyone that has dealt with similar issues please help!!

Contact the hospital where you will be at and see if they have a patient advocate on staff. They can act as a liason between what the insurance wants to pay for and what the doctor would like to do.

I used <>. I am 36 and had HPV with a previous LEEP procedure as well as previously suspected blood clot due to birth control. I had no problem with them. I decided on and scheduled my surgery all within 2 weeks time. Just stay on top of it. Good luck an keep us posted.

You should receive a letter from your insurance company after your doctor submits the pre-auth letting you know it has been approved or requesting more info. This should happen within 2 weeks or so after your doctor's submission. You can also call your insurance company and ask them. (number on the back of your card) They rarely deny this, it's all based on the info your doc gives. I'm a group health insurance agent, and also scheduled for surgery. Be proactive and call your insurance company and make sure everything is in order. You will feel so much better. Best wishes to you.

I HAVE SOME GREAT NEWS!!!!
Thank you guys for explaining your experience with this. My original plan was that I would have my pre op apt 7-2 and surgery 7-6. Well first thing Monday morning when I called to get test results back they informed me the results has not came back and I asked about insurance information with the hysterectomy and she then informed me that nothing has been submitted to insurance and that the surgery was not even scheduled and that my apt on 7-2 was not a pre op apt but just a biopsy follow up apt. I was furious and told her that I was told that it was a pre op and surgery date for the following Friday. She told me she would have the nurse call me as soon as the results came in. That night at 5:20 I got a call from the nurse who said the doctor had not reviewed the results yet and that she could just read what it said and couldn't explain anything but the doctor would explain it to me in 2 weeks at my follow up apt and if it would make me feel better she could put a note to ask my doctor to call and explain it to me when she reviewed them. THEN THE NURSE ASKED ME IF THE DOCTOR HAD TALKED TO ME ABOUT TREATMENT OPTIONS OR NOT? I was like yeah we have planned on a hysterectomy and that my "follow-up" apt was supposed to be a Pre-Op appointment! NO WHERE DID ANYTHING MENTION A HYSTERECTOMY so I continued to explain to her that the doctor recommended it and that that's what I wanted to do FOR SURE so she assured me that the doctor could explain things better and we could go over treatment options in 2 weeks and got off the phone. At 5:40 I got a 2nd call and it was from my doctor who explained that the biopsy confirmed there was cancer cells all the way to the skins basement membrane with some pushing against it trying to penetrate it and that would make it full blown invasive cancer. She said that with it anywhere from a day to a few weeks from becoming invasive she highly recommended the hysterectomy and jokingly I asked if I could come in the next morning lol and she told me that her scheduling coordinator would be in contact with me within 2 days to schedule it. I asked about insurance and she said that with it so close to invasive that there would be no problem what so ever. The next day at 8:05 I got a call from the scheduling coordinator who said that we could do it 7/5 as long as the doctor was ok doing it after the first one that was already scheduled but that it would be at noon. I agreed to that day and she said she would get back with me as to if the doctor would do it then. She called back and said that the Dr rescheduled the one that was already scheduled so we could do it that day. I asked her about insurance as the doctor said she would be the one dealing with submitting everything and she said that my insurance dont necessarly require a pre approval but just a pre notification so there would not be any issue with that at all. They actually cancelled my apt on 7-2 and said she would mail me the pre op instructions and for me just to be at the hospital by 6am on July 5th!!!!!

Wow! So happy that they caught the cancer in time and the insurance won't be a problem. Best wishes!

Thank you... this sight has been a blessing! I'm only 24 and know nothing about any of this stuff never even dealt with ins until now cause I never go to doctor other than check ups and pregnancy and there is never unusual issues there. And I'd never even heard of anyone other than me having to need a hysterectomy younger than 35-40 until I found this sight its helped me sooo much!

Best of luck!

Thank goodness everything got worked out, and sorry you had to go through that mess. Take good care and stay strong!