Pre Op Problems With Insurance

I have a partial vaginal hysterectomy scheduled for 8/7/13. I did so much work to be ready for this...planned for kids to be cared for, job to be covered by a temp, household in order.
Now, just days before my surgery, I have no idea if I will even have it at all. My insurance company is saying that they need documentation of a failed ablation before they will cover a hysterectomy. Has anyone else run into this? I have not had an ablation.
The decision for the hysterectomy was mutual by my doctor and I after discussing everything. He seemed to think that even if he did do the ablation and mandatory tubal that I would need the hysterectomy later.
I am stressing out really badly now because of everything I did to plan this and not knowing if it will happen or not. I am sure my work will be very angry that they paid for a temp to cover so I could have the surgery and then I don't have it at all.
I have been trying to get on the phone with my doctor to see if he could talk to the insurance company.
We decided against the ablation because my mother failed three before her hysterectomy, I have a "severely" retroverted uterus which would make it difficult to perform and I am more than 10 years away from menopause. I have also read that the ablation is good for heavy bleeding, but the constant and irregular bleeding that I have doesn't seem to respond well after ablation. I have already failed hormone therapy. I was bleeding while still taking birth control pills. I tried the depo shot, but that just made me bleed constantly too...I was told this is a side effect that some women can have...lucky me.
The vaginal hysterectomy is the least invasive (no abdominal cutting like in the required laproscopic tubal that I don't need with the ablation since my husband had a vasectomy two years ago). I will still keep my ovaries, so I won't even need hormone replacement for menopause.
Everyone seems to be on board with this except for the insurance company. I am in pain from the cramping and constant bleeding and was really looking forward to the end of all of that.
I just don't understand how the insurance company can dictate medical care.

No, I never ran into this problem
In my opinion - decisions like this should be between a doctor and their patient - no one else
I hope it all works out for you

First, write up a letter outlining all of the above. In the last paragraph of the letter point out that you do not wish your insurance company to have to pay for the cost of a failed ablation PLUS a hysterectomy, considering everything stated above. Then contact your insurance company and ask to speak to a manager. Explain your situation and offer to fax or e-mail the letter immediately.

Insurance companies want to spend the least amount possible. They make their decisions based on average people, and they don't have the information your doctor has available. With the added information of the retroverted uterus, and family history, they may be more likely to consider your surgery to save themselves money.

You should not have to deal withthis. Thats what the doctor office is for. I am sure they will handle it if you let your doctor know. He is supposed to submit all the required paperwork. It might even already be approved but it hasnt been mailed to you yet.

(((Sweetansour)))

I am so sorry for all the added stress you are dealing with.

	Quote:
Originally Posted by sweetansour I just don't understand how the insurance company can dictate medical care.

	Quote:
Originally Posted by fnaylor1972 In my opinion - decisions like this should be between a doctor and their patient - no one else

Insurance companies get to have say because they are helping foot the bill. Those who pay out of pocket get to make the decision along with their surgeon. But when we ask the insurance company to pick up part of the tab, we hand over some of the decision making process.

As ((Mj69catz)) pointed out, likely part of the issue is simply that the insurance company needs more information since you are not the "average" patient so you are falling outside the "average" treatment plan. Your doctor's office should be able to either get this through for you or advise you as to what steps you need to take. Another advocate can be the customer service specialist in your insurance agent's office.

Don't panic at this point. I know it is coming down to the wire, but your doctor may be able to get in touch with your insurance company and get things approved in time.

i completely understand your problem. Mine is a little different. i scheduled my hysterectomy, got ins approval etc.... then my job announced they were closing. i HAD to have cobra. job hemmed hawed finally said we could have 1 month cobra... YAY. right? hmmm if it was only that easy. job ended 7/31 in theory cobra began 8/1 i paid for cobra on 7/26, as of 1 pm today 8/5 there was no cobra. surgery scheduled for 8/6 at 1030 am. hospital wanted to cancel. i called and called insurance company. i had copy of cobra application (dated and signed) which i faxed over but insurance company wanted authorized person from company. this was a problem since HR and just about every one other than custodial staff was laid off. but i wanted this done soooooo i hunted down president of our board and he got me fast tracked once he understood it was a emergency at that point.

what got me thru insurance? kept asking for a supervisor, until they gave in and gave me one. when i finally got one who could explain in simple English what i needed... i got it done. there is always some one higher up. don't give up!!! ask for fast track appeal if u need to. I got to keep my date (in the morning) and i am good to go! DONT GIVE UP!

ok just wanted to update you, even had ins problem afterwards with getting meds. but my daughter handled that! i hope to hear you got yours approved!

Well, It came down to the day before my surgery before I heard anything. I am denied and my surgery was cancelled. I am still in pain and the insurance company sent a letter the day after my surgery explaining that I have a normal shaped uterus. Nothing mentioning the retroverted position and that they had spoken with my doctor. I called the doctor's office to see what I should do next and they said all I could do was make an appointment to speak with him. He won't speak with me over the phone. The nurse said that he could do the ablation but wouldn't budge on the tubal that I adamantly refuse. There is no reason for a tubal when my husband had a vasectomy two years ago.
Now I am left with no alternative but to seek a second doctor and see if he will help me. I have an appointment set up for next week with him.
My work is very angry with me because of the prep work and that they paid for a temp to cover me and now I am going back to work without the surgery.
This whole thing feels like a nightmare. I am praying that the right doctor is out there who knows how to handle the insurance company and can end my pain.
I pray that no one else has to suffer like this. It just shows how the state of our health care is declining and isn't going to get better unless we get to the polls and make our voice heard there.
It is especially hard for me to swallow this since I work in the health care field myself. I am fighting depression, and trying not to give up my fight for an end to pain and constant bleeding.

(((sweetansout)))

I am so sorry for all that is happening.

You do have a couple options. One, talk to your doctor about why the documentation does not state that your uterus is in a retroverted position which could indicate an ablation is not right for you. Then, get that second opinion to see if your uterus is a normal shape or not and if an ablation is a viable option for you.

Another doctor may also be willing to discuss options besides a tubal. However, the reason a doctor may insist is that though you say your DH has had a vasectomy, your doctors won't have documentation of that. Even if you could provide it, vasectomies at times do fail and a pregnancy following an ablation is very dangerous. Also, though you may be in a monogamous relationship and would never, ever cheat, a doctor has to consider that it could happen. Most women are not likely to say, "Hey doc, I am married but having an affair with my neighbor."

Working in health care, your employer should realize these things happen--in fact, they should understand better than most employers. So yes, the whole situation can be frustrating for everyone, but you aren't the first and you won't be the last this will happen to.

Do you have a GP? If so, get in touch with that doctor and see if they can help you with the depression and pain right now as you jump through some hoops.

in there!

Oh, when you get a sec you will want to edit your survey to removed your hysterectomy date so ladies will know you have not had surgery yet.

i am so very sorry to hear this