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Insurance WONT let me get Surgery :( Insurance WONT let me get Surgery :(

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Unread 06-12-2003, 11:22 PM
Insurance WONT let me get Surgery :(

Hello My Sisters,
My Husband talked to the "Insurance" lady today. The Problem has been this. My (Dr.) who is has been my Dr. for 10 yrs now, he even walked me down the Isle when I married my husband. Is switching to a PPO plan only--no HMO's at all accepted into his office as of July 1st. He hates how the Insurance dictates to the Dr.'s & how to take care of the patient's, and says the patient's never get the proper care as it is.
So we of course have the HMO we thought it would be a simple phone call to get it switched over--WRONG!!! Open enrollment isn't until December. Now with severe Endo. I don't know how I am suppose to wait much longer with this problem.
All the other Dr.'s of this hospital I belong to are also switching to a PPO plan. He wants to do a TAH,both ovaries, cervix tubes the must all go, and then to laser my abdomen and bowels and the ligaments to my back--here is why for that reason: My Endo is even up in my abdomen, attached itself to my bowels, and to the ligaments to my lower back, they are pulling on them. The reason he won't do it sooner is because he did the Laporoscopy on June 4th and said I am still way to inflammed to do this big of a surgery. He said it could actually be life threatening if he went ahead and did it anyways--it could cause me to bleed to death. I am allergic to all anti-inflammatory meds, so I can't even take those. I have cried off and on all day... I am so burning mad at this insurance company--I would like for someone over there to endure the pain I have experienced for the last 2 yrs, just for 1 wk--they would switch me over in a day! I am truly losing my faith in this situation. Can someone Please offer some kind of support or suggestion--I am feeling very depressed about the entire situation--and this site is the only place I know where to turn to--my DH, has to be tired of this whole thing--I know I am.. So someone please
Thank you all for listening--AGAIN
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Unread 06-12-2003, 11:36 PM
Insurance WONT let me get Surgery :(

Hi my hyster sister and I am so sorry to hear about what you are going through. I hate that you are going through so much pain and for all this to happen to you must make it worse. I am a 32 year old mom of four children and had my hysterectomy after the birth of my daughter. I had a csection and a hysterectomy on the same day.So you can imagine what I went through. I may not be in your situation far as insurance goes. But I can say that God makes things possible. Just pray and I'm pretty sure He will pull you through this situation. Believe me there is a blessing that will come through. I am a living witness. Me and my daughter almost died during that whole ordeal. My other 3 children almost grew up without a mom. And everyday I have to be thankful that God spared me and my daughter's life. I'm still depressed about it. My daughter is seven months old and she suffered a brain injury and has mild cerebal palsy. So believe me, God loves you. I hate to hear you have to be in so much pain. I will pray for you and hope things will work out so you can have your surgery and live a pain free life.
Unread 06-13-2003, 12:36 AM
You Found the Right Place~!

Oh HUN~!

I'm so very sorry to hear about the trouble the darn insurance is causing you. I'll tell you what...I had the same problem here. My insurance doesn't cover specialists in my area. I had a terrible time finding a GYNO that would do the surgery who was in my network. I decided to go to a doctor that wasn't in my network and worry about the bills later (not a smart move) :confuse:. I ended up calling my insurance back (after some ray and I found a doctor who was in my network. I had to get the surgery and the doctor who did it wasn't the real concern for me. I have been up in arms about this major run around that I had to experience to get the continued medical leave I need and to get my surgery scheduled. Well, I still don't have a date but I have an appointment with a new

I guess what I'm trying to say is that if you stick in there you will get this all sorted out. Lean on your higher power and let that be your guide. You don't need to suffer any more than you already have.
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Unread 06-13-2003, 12:48 AM
Insurance WONT let me get Surgery :(

I would put up a fight.. or at least try your best to. My insurance company has been processing claims with my gyn as out of network, which they said on their website that he was in (which is why I went to him -- our first appt was the pap that led to colpo/biop that led to the LEEP that led to the hyst... What a great new patient I am!)... They told me that his contract was no longer valid. I said, "Excuse me? You mean to tell me that I have gone through so much with him and I am scheduled to have major surgery in 3 weeks that he is doing and you are not going to cover it?? WRONG."

Guess what? An exception was made. Try try try.

Prayers and hugs to you!
Unread 06-13-2003, 03:38 AM
Insurance WONT let me get Surgery :(

I'm so sorry that you are going thru all this heartbreaking and pain. All the rules with insurance companies can be such a huge heahache. Is the doctor that is doing the surgery your primary care physician? The suggestion that I had is to see if you can get authorization or referral to have your doctor do the surgery even though he is out of network instead of trying to switch to the PPO plan right now. They might do that since you have a long history with your doctor and that he is switching to the PPO during your care. You might call the insurance company and see if they do referrals to out of network drs in special circumstances and see what the rules are to have this happen. You might have to go thru a primary care physician that is in their HMO plan to have this all happen.

Also check with the person who deals with insurance companies at your doctors office to see what can be done to have your doctor do the surgery. If he doesn't take HMO patient's, will he make an exception in your case because you can't switch to a PPO plan right now and you have been going for such a long time.

The other suggestion is to call the insurance company and see if they have any special circumstances that allow you to switch to the PPO now. Sometimes they refuse to switch at first and don't explain the exceptions to the rules, which almost all the time there are exceptions to all rules.

Good luck and I'll be thinking and praying for you.

A huge

Unread 06-13-2003, 02:18 PM
Insurance WONT let me get Surgery :(

I'm so sorry you're going through this. I was in pre-op on May 18, in the adorable "designer" gown and booties waiting to go into OR and the insurance company declined the surgery, because my dr was out of network too.... needless to say, it was a very stressful afternoon. I've contacted my State Rep, the Insurance Commissioner and am working on the Governor. Florida has a major medical insurance problem that is being addressed in special legislative session next week, so this could get interesting. Keep pushing, keep calling, keep writing - then do it some more. If you pester them to death they answer you just to shut you up. Threaten them with legal action, let them know you are contacting all these people, but whatever you do, don't stop fighting. I've been going to my dr. for 10 years and he is so upset about lack of patient's rights as far as the insurance companies are concerned. They basically don't care, and don't understand how frightening and emotional this is for a woman to go through. I don't want this to EVER happen to another woman again, if it takes the rest of my life fighting it - it won't. Hang in there, it WILL work out. You are fighting this for not only you, but the next woman who will have to face this.
Unread 06-13-2003, 05:38 PM
Insurance WONT let me get Surgery :(

Hi Jackie

I'm so sorry you have to deal with this insurance stuff. About a year ago I needed Thyroid surgery and, of course, my doctor wasn't covered by my insurance company (in my network of docs). I called and talked to everybody that I possibly could - I did it over and over again, but they solidly refused. What I ended up doing was ask the insurance company who in my area was in the network. I then took the list to my doctor of choice and he picked out the one he knew best.

I have dealt with insurance companies all of my adult life because of so many health problems. Our insurance has changed so much over the years, at one time I couldn't stop my head from spinning from all the rules. I learned from the experience I talked about above to get all my doctors, therapists, dentists, and vision people who care for all of my family into the network during that short period of time you have to enroll. I had talked to all of them about being in the network that we had and, by the grace of God, all of them agreed to do the paperwork to get in!!!!!!!!!!

It took a lot of work on my part, but it was worth every second of it because now I don't have to worry about whether or not they will pay the bills. That is truely a blessing for my family!!!!!!

Insurance companies seem to rule the medical world now and it makes me both sad and mad. I wish it wasn't so.

Try my suggestion of getting a list of what docs are in your network and show it to your doctor. If all else fails, he might know one of them and that they were good at doing the procedure.

I'm sending you a big and now I understand what you were chatting about last night in the chat room. Please let us know what does happen.


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