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Insurance Denied Insurance Denied

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Unread 12-10-2004, 11:31 AM
Insurance Denied

Well, I just found out that my surgery has been denied by my insurance company!

I will not be having a hysterectomy, I will be having a hysteroscopy and DNC instead. The insurance company says that my doctor has not exhausted all of his abilities yet, and so therefore, they have denied the surgery. I believe that there are other reasons behind it, but, I will look at this as an act of God because I truly believe that my husband and I were meant to have children!

Has this happened to anyone else?

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Unread 12-10-2004, 01:02 PM
Insurance Denied

Didn't happen to me, but I am curious....what did your doctor say about this?
Unread 12-10-2004, 01:19 PM
Insurance Denied

Well, the nurse is the one that called to tell me and she wasn't a happy camper. She said that the insurance company requested my record from her and she sent it. She said that she made sure to highlight the major problems, yet they still denied it. I honestly believe that they denied it because I will be switching companies in January.

It upsets me to know that the insurance company gets to decide what's best for me. I still have my appointment on Monday, so I will be asking a million and one questions about this whole ordeal. The nurse was blunt and said that they were full of crap, but what can she do? She said, "God forbid you get into a car accident or some how get cut, you would die because your iron is too low!" WOW! And I asked how they can deny it with that as a factor, but hey, what do I know??

I guess I should just be gratetful that something may be done to help my situation!?

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Unread 12-10-2004, 01:43 PM
Insurance Denied

Wow. I know all about insurance denials. Been there and still fighting it. My doctor thinks it is a bunch of bull too. However at least your company is allowing other things to be done to try and give you some relieve. My insurance company wouldn't even allow her to do a d/c to see if it would give me some relief.

Good luck to you! Keep us posted.
Unread 12-10-2004, 03:46 PM
Insurance Denied

My Ins said I had to try oral Meds (at least 3 kinds), a D & C or two or three, and a couple of other treatments (don't remmeber what they were called) and kept a daily diary of my pain and bleeding episodes 5 years and 3 GYNs later, I was finally granted a Hyst! I thought I was going to bleed to death! Hang in there! I don't know where some pepole say they give anyone a Hyst. It did not happen with me. Not with out alot of pulling teeth and selling the family farm!
Sched. 12-21-04 TAH/BSO
Unread 12-10-2004, 04:26 PM
Insurance Denied

I think you are lucky. My insurance didn't require a second opinion. I think my surgery was completely unecessary and I suffered a serious complication to boot. A very high number of these surgeries are unecessary. Insurance companies have every right and duty to see that other less risky and costly options have been explored.
Unread 12-11-2004, 06:57 AM
Insurance Denied

OK my question is I am scheduled this Thursday for TVH and my doctors office and the insurance company both told me I don't have to pre certify my surgery. I am stressing about what if they don't pay after I've had the surgery!!!! Any suggestions???
Unread 12-11-2004, 09:02 AM
Insurance Denied

Call your insurance co and ask about being pre-certify. My doctor did it for me and the insurance co sent me paper work about it.
Unread 12-11-2004, 06:00 PM
Re: Insurance denied

This happened to me last week. I was scheduled for Tues., Dec. 7 and got a call on Monday at noon from my doctor, saying insurance had denied the request due to my records showing "lack of less-invasive attempts" to solve the problems. I was absolutely beside myself, and angry too. I asked the nurse if they typically scheduled surgery before the insurance had been approved (I'd had the date for 6 weeks). She said they just didn't anticipate a problem. They submitted more information: the dates I'd tried the pill, how the pill made me depressed (and since I'd been on prozac in the past, they did believe I tended towards that); how an endometrial ablation is specifically not indicated for pain, how I was taking so many naproxen my stomach hurt after the first 2 days. I had also written them a 3-page letter, detailing very explicitly what I go thru each month. They did approve it, as of Friday. I now have Tuesday, Dec. 14 as a date, but I tell you, it was horrible going thru last week. I soothed myself by remembering that at least I had insurance and some people don't, and I'm lucky in so many other ways. Still, I was shocked. Good luck to all, and persevere. I read an article recently that said many HMOs who received appeals did reverse their decisions; they assume people won't bother and will give up.
Unread 12-11-2004, 10:08 PM
wish mine would have denied

I wish my insurance company would have denied it.My doctor is a slickl one he lies on his reports I should report him to the insurance company.He said I had heavy bleeding and did not,I had an unneccessary surgy,I thought is was pushing on my bladder and it was just nerves due to my ms.I am a mess now he ruined my life and my one child's chance to have aaa brother or sister.I felt better before the surgery.Can you call your insurance company and tell them?

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