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Insurance company blues Insurance company blues

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Unread 05-09-2002, 09:58 AM
Insurance company blues

Hi all,

Having my hyst this Saturday. My doc's office just called for authorization Monday and everything is a go. I was a bit worried about that because of all I've seen here about insurance denials etc.

Not all smooth sailing though.

My doc wants me in the hospital at least 2 days if I have the LAVH and at least 4 days if I have the TAH. Insurance company says I can only have 23 hours for LAVH as it is an outpatient procedure. I can have a whole 2 days if it is TAH. The docs office called me and told me that my doc really is not pleased with this. She suggests maybe I can get further with insurance company.

I probably was not too nice since I asked her if she was nuts that major surgery is an outpatient procedure. She told me that most people go home after an overnight stay with LAVH and in two days for TAH. I told her about this board and also told her that I never saw anybody going home the next day for an LAVH and certainly not in 2 days for a TAH. I asked her where she gets her info. Again, she says that most women go home in this time frame. I continue insisting that I am sure that is not enough time because I had to be admitted overnight for my uterine uplift which was supposed to be outpatient and had a two week recovery when it was supposed to be 2 days. I also expressed concerns about complications and her response was that complications are usually caused by the surgeon's errors.

Of course it is NEVER because the insurance companies don't want to give us enough time to recover.... Anyhow, I tell her about my asthma and my mild mitral valve leak and she says if there are complications that I can stay. She suggests that my doctor talk with their doctor if he disagrees with them.

My doc talks with their doc and both agree the policy is really stupid, but their doc has to follow their procedures. My doctor says that he thinks I will be in too much pain. If I am in too much pain, they can call the hospital on Monday morning and get authorization for me to stay another day. Problem is, I am having surgery on Saturday and by Monday morning I will have already stayed another day. Doc says I need to decide what I want to do and I told him I have no intention of going home in lots of pain and I will fight with the insurance company later. He told me to call them and tell them I had no intention of going home in too much pain. So I did.

Turns out the insurance lady is a nurse and she will go by the nurses report of my clinical and my needs, but doesn't understand why I have no idea what she means by this. she won't tell me if I push my pain button lots of times if that means I am in pain.....etc.... She says if she can't decide by the nurses report of my clinical and my needs then she will give to the doctor who also thinks this is stupid, so hopefully he will approve. She also finally says, these things are based on the average and your case will be evaluated as an indivdual case. If you need to be in longer, then you will be.

*Too bad I have to stay the extra day before they approve or not. I have enough money in my flex plan to pay for an extra day. It just really makes me mad that they get to decide what is best for me. According to her, I will recover better without being woke up all through the night. Hmmm, let me see, don't they do that to check vitals and make sure I'm ok?

Anyhow, thanks for listening to my long vent!
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Unread 05-09-2002, 10:19 AM
Oh my goodness

I'm so sorry you are having to go through all of this. Insurance companies can be a pain in your rump. My gave me 2 days but if I need more then the doctor or nurse has to call. They must think we are made of steel or something. I hope and pray that everything works out for you. And good luck and best wishes on your upcoming surgery.
Unread 05-09-2002, 10:41 AM
Insurance Company Blues

I have sympathy for you!! I sure know what you are going through, but mine is with the Dr.'s office.

Not the Dr. directly,or even his nurse, but the secretary...or idiot as my DH & I have named her. She called and sheduled the surgery for me and told me the paper work would be in the mail for me. When I got it, it has the date & time I should be at the hospital, not which part though. We just had a new Women's Paviliion added, and then there is the old hospital still, as well as day surgery. But, here is the real kicker, it tells me I am having a Total ABDOMINAL Hyst., and that I will NOT be admitted. So speak with the Idiot, and tell her I have NEVER heard of anyone having a TAH and not being admitted. She tells me..."Oh, I must have been thinking of some other surgery, like tonsils & adnoids" OH MY G*D!!!! She works for an OB/GYN, why on earth would he be doing a T & A???????? She looks in the book to make sure that the paperwork she sent to the hospital tells her that I am having the correct surgery, and thank God it was right. So I ask her if I need to call the insurance company for pre-notification, and she tells me no. I told her I was anyways, since she sent the paperwork in with me NOT being admitted. She says, "Well, yeah, I quess maybe you should call them then" ya think?? Turns out my insurance will approve, in advance 2 nights, and if I need to stay more, they will approve it based on my past history with Anesthesia and problems in the past.

So, my husband needed some paperwork signed by the Dr. so that he can use his sick time, instead of vacation days to be home with me for the 1st 2 weeks, the letter had explicit directions with it, as well as on the form the Dr. filled out as to what to do with it once it was completed. So what does the idiot do????? Call to ask what she should do with it, and once it has been faxed, should she just throw away the original!!!!!!! :explode: NO!!!!! I'll come get it later today!!! I really wonder if the Dr. knows what an incompetent person he has working with him. When I go for final consent, I am going to tell him what has happened. He is really the best Dr. I have EVER had. Just has an ignorant secretary!!!

Best of Luck with your surgery, nadn let us know how it goes. Mine is June 3rd. Need to be there, wherever there is, at 7am
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Unread 05-09-2002, 10:44 AM
Insurance company blues

What a nightmare! I am so sorry you have to battle this right now! Like we don't pay enough for our insurance! Then God forbid we need to use we are punished for it....Grrrrr
Unread 05-09-2002, 10:57 AM
Insurance company blues

Hi~~ I had a TAH/BSO and I came home 2 days after my surgery. I was more than ready to come home. My insurance okayed 2 days but more would be allowed if I needed it. Good luck to you.

Unread 05-09-2002, 06:49 PM
Insurance company blues

Dear Reneeo,

Here is a for you, for your Saturday visit to the castle. My thoughts and prayers will be with you for a safe and speedy recovery!

I too have had insurance troubles. At this point, I am only "penciled in" for my TAH on June 13th until insurance approves. I will find out about approval a week from tomorrow. Very stressful!!

I am wondering now, how do you know how long you're allowed to stay? Does your DR tell you? I will certainly ask at next appt. It's so maddening to think somebody behind a desk is deciding when you should leave without ever knowing how the surgery actually went and how you're recovering, as it most certainly is different for everyone!

Hope you have printed a copy of "How to Care for a Punctured Princess" for the person taking care of you. I plan on sticking the list everywhere there's an empty space on my walls for my DH! Take care and let us know how it all went when you get back..

: June Bug....Lauren
Unread 05-09-2002, 07:18 PM
Insurance company blues

Hi again~~ It was my insurance company that sent me a letter telling me how many days I was approved for. They also sent a copy to my doctor.

Unread 05-10-2002, 04:30 PM
Insurance company blues

I was actually shocked that my insurance didn't make me do anything weird at all to get my TAH/RSO, even though I am only 25 years old. i figured they would have LOTS of opinions about that one. I didn't even need to get a referral or any kind of pre-approval. I disn't believe them so I stalked down the on-site insurance company nurse at the hospital (i work there so I knew where to find her ) and I made her look it up twice AND call the Dr. at the ins. company because I didn't even believe HER. It was kind of she is scared of me i think.

BUT...I get what you mean about the "Idiot" doctor's office has one too...she sent through my surgical reservation form ALL wrong, it had the wrong procedure on it, and I had to get a new one, then she keeps putting the wrong insurance in their stupid computer so every time I go in for anything they bill some bizarre insurance company I don't have and then I have to call after the fact and get it fixed...she is a total moron. Thankfully, my doctor is the best in the world, and he lets me e-mail him directly with all my issues so I can cut out the middle-man...hee hee He also knows that she is a total idiot so we kinda make fun of her. (The hospital assigned her to him, he didn't have much say)

I hope that you get all this worked me it is worth it to get it all right BEFORE rather than dealing with a mess AFTER when you feel like poo.

Good luck!

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