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Insurance approval? Insurance approval?

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Unread 01-01-2002, 11:29 PM
Insurance approval?

Can anyone clue me in on how common it is for the insurance company to deny surgery for hysterectomy? I won't know until tomorrow or Thursday if my surgery has been approved, but I'm a nervous wreck worrying that they will deny it! I have Aetna Managed Choice, btw. I have never had problems with them in the past, but I know this surgery is a *bigger deal* than any of my other surgeries. I guess I just don't understand how an insurance co. can deny something that a doctor says is needed.
Any info. is much appreciated! And s to all the wonderful women here!
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Unread 01-02-2002, 01:02 AM
Insurance approval

Dear Julie,
Hi I had my hyster on 12-18-01. I also have Aetna so we are dealing with the same insurance company. I had gone to the Dr on 12-08-01 and was approved and in the hospital 10 days later.
I think approval depends on the diagnosis and how good your Dr's billers are at getting it done. My dianosis was cancer in situ , 15 tumors and high grade squamous lesions. So it was very fast,. How ever my Dr's staff is also very pushy and I was also calling member service's to make sure all the I's were dotted and the T's crossed. Do not hesitate to call Aetna and ask were you stand. After all you pay them every month and you will do whatever is nessacary to help them move it along!
Hope this helps you. If you have any other questions please feel free to email me as I have become quite the "old hat " at dealing with insurance!! LOL
Unread 01-02-2002, 03:40 AM
Insurance approval?

I have Amerihealth Point of Service and they originally denied my surgery. They ordered more tests, endometrial biopsy, blood work, etc. Only after they put me through hell did they finally approve it.

I posted about this back in November when I was going through it.

Keep on them and good luck.
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Unread 01-02-2002, 03:49 AM
Insurance approval?

I had Humana PPO at the time of my surgery, and I also was worried about getting approved, since several years ago a co-worker had to fight to get hers approved. But, I was approved with absolutely no problems.

I think, as Barbara already said, that it depends on the company, on your individual diagnosis, and on your doctor's office staff. And depending on what you have already gone through, you might want to give them the benefit of the doubt if they suggest another test or procedure. This is major surgery, and if there is something that can be done to solve the problems without it, that's always worth a try. However, to have to go through unnecessary tests and procedures is frustrating!!

Good luck.

Unread 01-02-2002, 12:59 PM
Insurance approval?

I have Aetna HMO. I talked to them before I scheduled my surgery. The person I talked to didn't think there was any problem. My Dr tried hormones to control my bleeding first, that's been about three years. I had an ultrasound last month, and my fibroids and uterus have grown, a lot. My uterus is now 16 week pregnancy size. When I was scheduling the person who was handling the arrangements in the dr's office said there shouldn't be any problem with the insurance company. I am going to call the consumer number in a couple of weeks to make sure everything is a go.
Unread 01-02-2002, 01:29 PM

I have Antheum BC/BS. Surgery was on 6/21/01 the day of surgery in the mail is letter saying they needed more info. from Dr. DH got the letter when he came home from hospital. Calls and tells me about it. Brought to me gave to Dr. they called. On 7/27 a little over a month after the surgery Ins. finally okayed the sugery. I guess the Dr. provided enough proof finally, or they thought they may as well since surgery was over
Unread 01-02-2002, 03:37 PM
I had no idea!

I had no idea what a hastle insurance companies can be! I'm so sorry to those that have had to struggle to get what you needed. I think it's criminal for the insurance to put women through such nasty tests and then sometimes STILL not give approval. I got a call a little while ago from the 's office and my surgery is set to go on the 31st of this month. The insurance co. gave the ok and also approved a 3 day castle stay. ..... Now I just pray that they don't change their minds or find some reason to delay it at the last minute! The poster who had that letter in the mail ON the day of your surgery, that is just awful! Just scary! I really hope that this is it for me. But, with some of the stories I've read on this site and others, I'm afraid to get my hopes up. I guess I'll be a little worried still until the surgery is over with....

Thanks so much for sharing your stories! You ladies are the ver best! s to all of you.
Unread 01-02-2002, 06:43 PM
Insurance approval?

I was pleasantly surprised at my insurance company's (BCBS HMO) handling of my hyst approval. My primary care physician told me it was likely that the insurance company would make me just through some hoops before approving the surgery - maybe some kind of drug therapy or a D & C, then "wait and see". Of course, my PCP kind of seemed to have a "this is just something you have to put up with" attitude to my relatively minor symptons, but she didn't argue about a GYN referral when the ultrasound showed my fibroids had doubled in size in 2 1/2 years. The surgeon recommended a hyst, if I was OK with that (I am!) and submitted the request to my insurance company. Less than a week later, I received a notice that my ab hyst was approved, no further questions asked.

I was really glad not to have to fight with doctors and the insurance company. Some of my friends have had to fight for years to get a hysterectomy, even though they were bleeding so much they were anemic.

Unread 01-03-2002, 05:58 AM
RE: ins approvals

Healthnet/ hmo here, tends to be a lil picky. But from what I learnt yesterday, I have been approved for this for a month.
Who knows what makes these ins co's tick, perhaps the diagnostic lap I had in Nov made the difference as for "proof"
Perhaps even the prob, my main prob, adhesions, doesn't have alternative treatments other than pain management.

Saw some sisters posting that are on or near my date
Keep up and let's compare notes plz

Unread 01-04-2002, 09:56 AM
I got approved - whew!!

I found out yesterday that I was approved. I hadn't thought about it much since I hadn't heard anything to the contrary, but in keeping with me stressing out about every little thing, I decided to make sure I have Aetna, and it went very smoothly apparently - they didn't even question it. I was pretty surprised, I was expecting at least some kind of hassle

I hope yours goes through - I can't believe that an insurance company would disregard the recommendation of a doctor and fail to take into account the amount of pain we're in, all for the sake of saving a buck. I hope someday control is taken away from the insurance companies and put into the hands of the doctor and patient!!


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