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insurance wont give the go ahead..... insurance wont give the go ahead.....

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Unread 06-14-2004, 01:26 PM
insurance wont give the go ahead.....

hey all..... in a hard spot here..... scheduled for surgery in the am...... insurance fighting it!! anyone have ideas. please help
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Unread 06-14-2004, 01:35 PM
insurance wont give the go ahead.....

I can totally relate! I also had insurance problems. The first time, I knew my surgeon was not on the network, but I planned to pay his fee myself. However, the HMO said I had to use a network doctor or they would pay nothing. So I went to a network doctor. Two days before surgery, it was denied again, because "I hadn't had enough procedures done." My doctor didn't cancel the surgery because he figured he'd do a D & C just for the record. My doctor and his staff were wonderful. They spent an enormous amount of time fighting the insurance company. My doctor had several conversations with the Medical Director of the HMO. He basically told him I didn't need a D & C and it would not help me. He again went over my medical history. He faxed every document he had to the insurance company several times. My husband called in the corporate representative with the HMO (who happened to be there that day). I also made several phone calls to the insurance company. Basically a compromise was reached. The HMO said if I had a negative thyroid test, I could have the surgery. My doctor called me and told me to get to the hospital as fast as I could. They would rush the thyroid test and all other pre-op tests, as now it was the afternoon before the scheduled surgery. At 4:30pm on Tuesday, I was approved. I had surgery at 7:30am Wednesday.

It was a nightmare dealing with the insurance company. I never realized how much power they really have in determining the care we will or will not receive. However, everyone on this site was fantastic. I know many people prayed for me and I believe that is what made the difference. I will pray for you, as I know how upset and frustrated you must be.
Unread 06-14-2004, 03:10 PM
insurance wont give the go ahead.....


When they deny pre certification they send the subscriber a letter explaining why. Sometimes something in the paperwork that was submitted to them by the DR's office was coded wrong and all it takes is a call from your DR to the MRO to get it straightened out.

Sometimes their protocols tell them that there is another, less invasive treatment that hasn't been tried yet, and once again a call by your DR to the MRO explaining why it's not a good idea can take care of things.

Insurance companies get blamed both ways - hysterectomy critics claim they say yes too quickly because they want to save money instead of trying alternatives, and then there are those who say they don't want to pay for them so they deny them and force patients to try less expensive alternatives first.

I hope this gets straightened out for you, but remember, sometimes these things happen for a reason we may not understand at the moment.
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Unread 06-14-2004, 03:26 PM
insurance wont give the go ahead.....

You poor thing! I will pray for you as well. I am not sure this will help you in your current situation, but I have no insurance at all. I was able to schedule my surgery at a community hospital where they do financial aid for those who need it. I am able to have 100% of the surgery and hospital stay written off. I got a great deal from my doctor for his portion of the bill, and he called and got the pathology lab to give me the same deal. It all worked out, and it is extremely affordable! (as much as surgery can be) Being a single mom, sometimes we have to take the unconventional route.... good luck!
Unread 06-15-2004, 02:29 AM
surgery cancelled!

after fighting on the phone all day and doing everything i could think of..... we had to cancel the surgery... and the claim is being appealed..... held out strong til the last minute.... then lost it, the tears came and came.
Unread 06-15-2004, 03:23 AM
insurance wont give the go ahead.....

Oh. I am so sorry for you! I'm in the UK, so don't really understand how your insurance system works, but thought I'd let you know you have my full sympathy. Let's hope the appeal is quickly resolved in your favour.

Unread 06-15-2004, 09:01 AM
insurance wont give the go ahead.....

Lots of hugs are being sent your way. I am so sorry your surgery didn't go through. I'll pray that your appeal works and your surgery is quickly rescheduled. The insurance company will send you a letter outlining why they denied the claim. Talk these reasons over with your doctor and perhaps there can be a compromise. Good luck!
Unread 06-15-2004, 10:26 AM
insurance wont give the go ahead.....

so sorry to hear what your going through...i had the same problem with insurance...since i am not working i had to get medicaid, cant afford insurance...they are a real pain too!!
i had to go through hormones that made me want to kill people, then 2 times i had to do biopsy's then had to have a LEEP procedure done with a D&C...then again some more hormones....then finally my OB/GYN had me take a second opinion paper to my primary doctor to fill out saying YES she needs surgery and POOF there it was...not saying that i will help but have you tried getting a second opinion paper signed? it really speeded things up for me...i will pray that you get the approval...Good Luck.......

Unread 06-15-2004, 06:31 PM
Insurance Trouble

I am having trouble with my insurance also. My surgery was approved two weeks ago and today my doctor's nurse called and told me my claim was pulled by my insurance's review board and they felt since I have not had a D & C yet they would deny my surgey, or at least part of it. The insurance company will allow my doctor to do the part of the surgery where he has to cut me "oh about 3 - 4 inches" (abdominaly) to take out my right ovary and a tumor that has engulfed the ovary. I will be off 3 - 4 weeks, but they will not pay for the hysterectomy. They want me to try a D & C and if that doesn't work than I can have another surgery. I am fighting it, I went to the HR department today and am getting help from them, and my doctor is helping me appeal so I do not have to have surgery twice. It's crazy.

Well here is a big for you and I hope everything works out for you.

Take care, Muniera
Unread 06-15-2004, 08:31 PM
insurance wont give the go ahead.....

Sorry to hear about your problem. I didn't know you had to get it pre approved. Does your doctor do it or do you have to? cause I really need to check in on that.

GOOD LUCK on fighting with the insurance company

Hope everything works out for the best

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