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Stand Up for Ourselves Stand Up for Ourselves

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  #1  
Unread 05-23-2003, 09:07 AM
Stand Up for Ourselves

I read in the newspaper today that a major insurance company has agreed to pay $170 million to settle a doctors' payment suit: "Doctors claimed insurers shortchanged them and interfered with their recommended treatment for patients."
About 7 years ago, I had a "drive-thru delivery". I arrived at the hospital on Friday night and was home on Saturday night. The prolapse that caused my recent hyst occurred 3 months after that birth. Would a longer hospital stay have helped to prevent it? I'll never know. (I do know that if my doc had warned me not to lift anything heavy, I would have listened, but that advice was never given. I helped my DH move a dresser 3 months after the birth, and the prolapse showed up the next morning.)
This past April, I had what could be called a "drive-thru hysterectomy". The surgery was done by 9pm Monday and I was home in my own bed by 9pm Tuesday. I thought it was standard procedure not to release a patient until they were able to eat, drink, take a shower, pee, and have a BM. I was able to eat and drink, but the other requirements were never proven. I went home with a catheter, there was no shower in my hospital room, and passing gas was considered proof that the bowels were working. Since I wasn't able to have a BM for 5 days after surgery, I think that theory is wrong.
I read on this website of a woman who was sent home 2 days after a hyst instead of the recommended 3 days. She had to come back to ER with complications, and her doc actually apologized and said insurance companies were pressuring him to release patients earlier.
Hysterectomy is MAJOR SURGERY and should be treated as such. Our insurance premiums are high enough to allow us proper treatment. During my short stay at the hospital (which, by the way, is rated as one of the top 100 in the country), I kept hearing my doc and the nurses say it was good I was being released because I would be better off at home. Sad statement on the condition of hospitals today. Aunt May
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  #2  
Unread 05-23-2003, 12:11 PM
Stand Up for Ourselves

Hi Aunt May Yes, it's sad that sometimes ladies are sent home before it is really safe for them to be home, just because insurance won't pay for the longer stay.

I think a lot of it depends on whether or not the DR feels comfortable pressing the insurance company for the additional night(s)' authorization. For example, for my insurance company, it's very common to have only one night pre-authorized for a hyst. My DR assured me up front that once I was out of the OR, one of her first tasks was going to be to call the insurance company, tell them I was not going to be ready to go home in 24 hours, and get a second night authorized. And so on, until I was ready (in her opinion) to go home and be able to manage by myself.

The insurance business is a very tough, competitive one. The way insurance companies compete is by offering coverage similar to that other companies offer, at competitive rates. They set their rates by using statistics on how much they should have to pay out on an average claim, considering the insured's age, sex, etc.. They figure that many DRs will just accept the authorization as given by the insurance company and not argue for a longer stay. Whether you get a longer stay or not may depend partly on how comfortable your DR feels about arguing with them. They make it hard to do because if everybody got a longer stay, they'd have to be paying out more in claims and they'd have to then charge more for premiums, and that would make them not competitive. Of course, if they all started authorizing longer stays at the same time, they'd stay competitive, but this is a case of nobody wanting to blink first.

Now, we all know that if they'd just authorize the longer stay in the first place, a lot of returns to the castle for complications could be avoided, and it might be cheaper for them in the long run. But the insurance companies don't look at it that way, because they consider the admit for the complications as a separate claim, not a higher cost on the first claim.

I think that this should be a consideration when any is considering who should perform their surgery. One question that should be asked ahead of time is "if my insurer authorizes x nights' stay, and I'm not ready to go home after x nights, what can you do about it to make sure I don't go home so soon that it's not safe? and how will you decide when it's safe for me to go home?" While many DRs are very sensitive to our needs very early post op, some seem more concerned with their reputations for 'getting 'em in and out fast'. JMHO, but if I encountered one of those I would run very fast in the opposite direction.

Thank you for posting this... you are right, a hyst IS major surgery and needs to be taken seriously. We need to educate ourselves about what sort of treatment we can expect to receive, and insist our DRs look out for us. We are our own strongest advocates!


-Linda
  #3  
Unread 05-23-2003, 12:41 PM
Stand Up for Ourselves

My dr also assured me that I would not be going home in a day or 2 I had my surgery on a Tues afternoon and was in teh hosp until Saturday afternoon and honestly would NOT have been able to go home sooner.
have I said how much I love my DR!!!
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  #4  
Unread 05-23-2003, 05:10 PM
Stand Up for Ourselves

Gee, now I'm a little nervous. I had TAH on Fri, May 16th. Originally my DR told me I could probably go home on Sunday. But when he came to see me that day, he recommended I stay another day. Insurance was never mentioned. I kinda wanted to go home, but I DID end up staying until Monday and was really glad I did. The extra day made a big difference in how I felt. I'm nervous now because after reading this post, I HOPE I'm covered. I always hate to "assume." My post op visit is on Tuesday, so I wil be sure to ask the doc, but unfortunately, I never gave the length of stay a second thought. Now I know I was foolish. I hope this mistake doesn't turn out to be costly.
  #5  
Unread 05-23-2003, 06:44 PM
Stand Up for Ourselves

Dear Pita05: I could be wrong on this, but if I'm not, it might give you peace of mind. I called my insurance company before surgery and asked what I would have to pay. I believe I have to pay up to $1,000, and the insurance company has to pick up the rest. If that is the case, no wonder insurance companies don't want us in the hospital for an extra day! It's their pocketbook they're looking after, not their customers.
Dear Surferbabe -- Thanks for your reply. It was important information. Sincerely, Aunt May
  #6  
Unread 05-23-2003, 06:47 PM
Stand Up for Ourselves

Dear Cher: I forgot to add a note to you. I just wanted to say I'm glad you found a good doc. I'm definitely not as happy about mine. Best wishes, Aunt May
  #7  
Unread 05-23-2003, 07:14 PM
my thoughts

As an employee of a hospital, what insurance will and won't allow comes up way too often. I was lucky with my surgery, I had a doctor that is pure and simply all about the patient. He told me that I could expect to be in the hospital 2-3 days. After surgery he told my husband I could expect to be there for about 5 days. When I questioned him about it he told me he had already contacted the insurance company and Informed them I would be there around 5 days so they needed to document that they had approved it. period. After 4 days I was able to go home. My insurance paid 100%. There are alot of insurances that still will not approve a longer stay no matter what the doctor does. We need to stand up and not put up with this crap anymore. We are in control of our own health care and we need to start acting like it!
  #8  
Unread 05-24-2003, 10:56 AM
Stand Up for Ourselves

Dear Jana: AMEN! You are so right about what you said. As I read messages from others, I'm glad to hear there are some doctors out there who genuinely care about their patients. I went to 3 docs before my surgery and finally settled on the third one, but I wish I had shopped around even more. Aunt May
  #9  
Unread 05-24-2003, 11:08 AM
Stand Up for Ourselves

I guess I'll see what happens with my insurance company, but my doctor kept me in 4 nights -- he might have kept me even longer, but I begged to go home. They kept me longer because I had a low-grade fever.

I WILL not pay for any extra days if my insurance gives me problems. My doctor made a medical decision, I had no input and as far as I feel, the insurance will either cough it up or the hospital will.

I just got the statement from the hospital, so I'll know in the next few days whether I'll have to fight the insurance company also.

Insurance companies will often deny claims they know they'll later pay -- they make money on that because they get to keep the cash longer and invest all that money. It's a big, big pain, but if you are willing to take the time to continue to fight their decisions, most likely, you'll always win. They make it difficult so that you'll give up.

This is why it's so important that we find doctors who are patient advocates. I was thrilled at my pre-op to hear that everyone kept saying what a patient advocate my doc was -- so there was no question about me staying longer. I don't know if the doc got it approved or not, but I'm sure he'll help me fight the insurance company if they decide to not pay for anything past two nights.
  #10  
Unread 05-24-2003, 02:42 PM
Stand Up for Ourselves

Thanks Aunt May. I'm not gonna lose too much sleep over it. Yet. At least until I start getting some bills. I'm only 8 days post-op, so it's still early. Also, I neglected to mention before, I have two separate insurance companies (from my job and my spouse's job). This could be a plus (or not). It COULD mean I have TWO companies to fight with instead of just one. Time will tell. I never was much for doing homework - even in school. But seriously, we gotta realize how important it is in this day and age of HMO's to be educated on our coverage.

Pita05
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