Ins rejected me. Hyst was to be today

I was finally ready emotionally to do this. Now insurance company wants me to do "conservative therapy" first. We, my doctor and I, decided this was what was best for me. Had everything arranged, i.e. flew mom up from SC to care for me, arranged Nanny to help with 2 and 5 year old etc.. Ins. co. had me jump through more tests, reviewed and rereviewed and rejected even after lap. I am so depressed. Been on Percoset for a month and facing another. Must do Lupron? What can I expect?

Oh, Amy, I am so sorry!

And frustrated!

I read your other post on the (new) pre-op board. Now, I am not a doctor, nor am I an insurance company. But I really fail to see how Lupron is a more CONSERVATIVE approach to your treatment. I'm not sure what "failing" this approach means - sure your fibroids will shrink, temporarily. Then they will probably come back. Now the ins. co. has spent more money than the hyst you would have had, and probably will have. Grrrrrrrrrrrrrrrr

So here's what I've been told, and what I read on the Lupron package insert today. Lupron will temporarily shrink your fibroids. Once you stop, they will probably grow back. Lupron is often used to shrink fibroids prior to surgery, to make a vaginal or laporascopic hyst possible. Lupron should not be used for more than 6 months. Many docs say no more than 3 months. Lupron may cause irreversible damage to your bones, and cardiovascular system (if used for more than 6 months, at 3 months it seems to be reversible), leading to an increase in osteoporosis and heart problems. Therefore, most docs limit their use of Lupron.

Basically, from what I know, Lupron is not a "fix" but a temporary treatment. Although the drug is costly (one shot is about $450!) it is, of course, cheaper than a hyst. Maybe that's what the ins co means by conservative? Cheaper? Lupron, according to the package insert, is not recommended for more than 3 months in treatment of fibroids. The average time for fibroids to return to their pre-Lupron size is 8 months. Again according to the package insert, Lupron is recommended for pre-operative treatment of fibroids because it will 1) temporarily shrink the fibroids and 2) most women will no longer have periods while using Lupron, thus improving the hematocrit levels of women experiencing anemia due to heavy bleeding. The package insert further suggests doing a test month of of using iron therapy instead of Lupron, as most women's anemia improves with iron alone.

That said, I am on my second Lupron shot, prior to a hyst on 7/11. I would NEVER repeat NEVER have taken Lupron if not for scheduling the hyst. I, personally, have not had bad side effects that are noticeable (but the bone and heart side effects could be "silent", altho at two shots they seems to be small, according to studies) - however, I almost felt that I was making a commitment to a hyst when I said ok to the Lupron shots. I would not do this over again.

Again - this is what I have experienced and read. Some women have MAJOR menopausal symptoms - hot flashes, headaches, moodiness, etc.

I would do what some of the women on the pre-op board suggested - write all your symptoms down, appeal to your insurance provider. Ask doc to do same. In my personal experience, Lupron is a great drug prior to surgery - I feel so much better without bladder pressure and lower back pain due to shrinking fibroids. BUT - they would most likely come back in a month or two.

I personally am so angry with HMO's and insurance companies lately. Sorry for venting that, but they seem to have the bottom line and not your health in mind. My humble opin.

good luck - keep writing and calling - don't give up!

Det. Dixie Tracy, Fibroid Investigator
[Edited by Dixie Tracy on 06-29-2000]

Amy,

I feel for you - that is the worst! I don't know why you're having the hyst (but I suspect, since you mention lupron <shuddering>, it's endo or fibroids). Two great resources:

1. http://www.patientadvocacy.org. This is a non-profit organization that helps people who've been denied insurance coverage. They can help you.

2. Check out http://www.endowalk.org on July 1. They run monthly articles, and the upcoming one is a step-by-step plan for fighting insurance denials.

Something you can do for yourself right now: collect information from respectable sources that supports your decision to submit to the company. You CAN prove to them that lupron is not a long-term (or even short-term) fix - it has bad statistics for efficacy as well as side effects, some of which can be irreversible. Also, have your doc write a letter to the company stating why this is necessary for you, and even consider getting a second written opinion as further proof to back you up. Best of luck! Don't let 'em get to you.