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New & Sooo Upset! New & Sooo Upset!

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Unread 03-15-2004, 07:17 PM
New & Sooo Upset!

Hi! I’m so glad I found you!! It’s only March and yet 2004 has been a bad year for my house.
Here’s my story (so far). I've always had terrible periods and just felt they were a fact of life. In 2003 they had gotten worse and I was having constant pain on my left ovary. I finally went to a DR and was told it's just ovarian cysts (deal with it). So I have. The pain and periods have become increasingly painful until the last straw in Jan. when DH found me unconscious and rushed me to the ER. The ER put a band-aide on my situation and sent me home. Several tests and visits to my DR showed fibroids to be the cause. His advice… “Watch and Wait”. I understand waiting on fibroids that do not cause pain but mine were slowly destroying my life! I had constant pain on my ovary and cervix, my periods had become excruciating and sex was out of the question (due to pain)! Of course I told all of this to my DR. He then changed his tune and said “Okay, hysterectomy then”. Needless to say, my DH removed me from the office before we had a lawsuit on our hands (I could have strangled him). I was so distort…No one cared and I felt like I was going crazy! I went to see another DR who was highly recommended by Nurse in our family. I believe her exact words were “He’s a medical genius”. Wow, she wasn’t kidding, what a difference! This DR listened to all my complaints, did a thorough examination, look over my ultrasound and blood work. BUT in the end, recommended a hysterectomy. Not just because of my fibroids but because my cervix was so badly scarred. I thought about having the surgery for a week and decided to go ahead(fertility was not a factor). My DR scheduled the surgery for 3/26. He told me I should not have to live in pain any longer. THEN just when I think I’m on the right road to living a pain-free life, my insurance denied my pre-certification! They’re reasons were that my uterus is not swollen ENOUGH, I’m not ANEMIC and I’m not bleeding ENOUGH (more than 8wks straight). I am stunned! I have been paying into this insurance for years and have barely used it! Now that I need it, they don’t want to pay? They can look at a piece of paper and say I’m not ____ ENOUGH? What about my quality of life? Doesn’t that come into play? Are there guidelines that have to be met before a woman can have a hysterectomy? Lord knows I wouldn’t just volunteer to have unnecessary surgery!

Thanks for letting me vent & I’m eager to hear your advice!

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Unread 03-15-2004, 08:00 PM
Take a deep breath!

I am new too, only been here a couple days.

I bet your Dr. has seen this type of Insurance denial before and will be willing to resubmit. Sometimes they need more detailed information from your Dr. Call the Dr.'s office and see what they say.
Remember this is also the second Dr. who said you need surgery so you have two opinions. Perhaps that would work in your favor.

I know you should not have to fight your insurance company but it happens everyday and with the help of those in the medical profession I believe there is a good chance the insurance company will change their minds.

You and your situation are in my prayers !
Unread 03-15-2004, 08:25 PM
New & Sooo Upset!

Hi, I'm new, as well.

Gee, you'd think that after all you've been through, they would approve your surgery, but that's health insurance for you... what a pain!
One has to be very strongly persistent in these matters!

Because I've dealt with health problems for so long, as well, and had to apply for disability, one has to be persistent, persistent, persistent. (especially out of necessity).
What one needs to do is work with the doctor on getting the wording right on the request for approval. Crazy as it sounds, it's a word game more than anything, just based on what I've been through for over a decade.
In general, depending on the health insurance you are on, they have people looking over the forms for certain catch phrases, without really looking at the overall situation.

I hope it works out for you soon!
Unread 03-15-2004, 09:58 PM
New & Sooo Upset!

My dr said when we scheduled surgery that I may be rejected. He said if that happens let him know and he would take care of it. I really sweated over this cause whe had tried everything, drugs, hormones,thermal eblasion, birth control, you name it and they were possibly going to say it wasn't warrented!! Put your trust in your new dr. He will help you out. I really wonder though,,,,who at the insurance companies know more than the docs or the patient to make that kind of decision......I wasn't rejected and am now 2 1/2 weeks p ost thing I ever did!! Good luck.

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