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Insurance denied - now what??? Insurance denied - now what???

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  #1  
Unread 03-20-2005, 05:30 PM
Insurance denied - now what???

I am so bummed out. I honestly don't know what I am going to do. I thought that insurance was approved and everything was in it's final stages - now I've found out that not only was the surgery not approved but my insurance was denied completely so I still don't have insurance and I'm still needing a hyst and I don't know what to do.
I'm going to start the appeal process but that can take up to 90 days again. I've already been dealing with this for almost 5 months - the pain is unbearable sometimes - I can't work - I can't start school. My life is on hold.
I'm just at a total loss. Hoping that someone has some ideas, advice. I'd appreciate anything at this point.
Thank you.
Tammy
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  #2  
Unread 03-20-2005, 05:38 PM
Insurance denied - now what???

Without knowing your situation, I wondered if you could be eligible for disability and/or medicaid through human services. Might be worth checking into anyway.

I will be thinking of you. Good luck!
  #3  
Unread 03-20-2005, 05:44 PM
Insurance denied - now what???

Oh Tammy,

I am so sorry to hear that! I have read here that many ladies do appeal the decision so that is probably a good way to start. Have you discussed other options that may be available to you with your doctor?

I wish you the best and I pray that everything will work out for you! Please keep us posted!

s

Deb
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  #4  
Unread 03-22-2005, 07:59 AM
Insurance denied - now what???

Thanks for the replies. I appreciate it.
As far as the disability is concerned; I can't file for disability until I've been off work for a year, and I'm not eligible for medicaid I already tried.
The Dr says I need a hyst - but the hospital won't let me in the front door until I have some kind of insurance. He can't do a lap or anything.
I'm going to see another Dr today. I'm having complications with severe rectal bleeding and I know that it's all linked to this cyst and endo. My colon is adhered in all this mess and so maybe with it affecting my bowels they might actually have to do something and just wait for insurance approval later.
I'm dreading it - I know that they are going to have to do all kinds of embarrassing and uncomfortable tests. But maybe it will all work out for the best.
Best wishes to all.
Tammy
  #5  
Unread 03-22-2005, 08:40 AM
appeal

I am so sorry you're having to go through all of this, Tammy. I used to handle appeals for my employer's self-funded medical plans. You should definitely pursue the appeal Be sure to include in your letter of appeal the diagnosis, underlying symptoms, additional complications. In particular be sure to detail what alternative measures have been tried, the results, and those you have not tried and why not. If you want to PM me, I will be happy to review your letter before you send it out. You want to keep it unemotional if possible (I know how hard that will be!). It's a lot of work, but frankly, it can't hurt and might help a great deal to go through the process. Get your doctor involved throughout this process, as s/he has had to do this before - his or her office might have someone skilled in writing appeals.

It would be helpful to know the exact reason for the denial - sometimes knowing that can help you craft your response. I'll help if you want.

cj
  #6  
Unread 03-22-2005, 06:08 PM
Insurance denied - now what???

Tammy,

I'm so sorry to hear about all of this. I work at a Catholic hospital and there are some instances where they can write off expenses as "charity." I know it'll mean swallowing some pride, but, if you need you need it. You sound so miserable.

Take care,

Rhonda
  #7  
Unread 03-23-2005, 09:27 AM
Insurance denied - now what???



I know how you are feeling. It took me 6 months to get my approved. I had my surgery date and everything then a week before the surgery they decided they would not pay for it so we had to cancel the surgery. I went through the appeal process. It can be very maddening.

Has your doctor called the company himself? My doctor did that as well as send letters. You can also contact your state commissioner on insurance and make a complaint if you need to and they can review the case. That is what we ended up doing as well as getting legal advice from an attorney.

Good luck to you and if you need to talk feel free to PM me. I know exactly what you are going through.
  #8  
Unread 03-23-2005, 01:45 PM
Insurance denied - now what???

Tammy,
needsomerelief is right. Have your Dr. call those insurance bozos cuz they are obviously clueless here. My Dr. has yelled at my insurance co. many times and has always been successful(of course she's not the type of person ya wanna make angry heheheh I LOVE HER!!)
Honestly!!!...If your "parts" are adhered to your bowel (mine was too)do they actually think that will resolve on it's own? Boy some of those guys just need a firm push from a Dr. or you(or at least a good swift kick in the rear) and they get over their issues quickly.:burning:

Best of luck to ya Tammy.
  #9  
Unread 03-30-2005, 11:34 AM
Insurance denied - now what???

Hello all! Thank you so much for all your support and ideas! I've been making lots of phone calls and come to find out there is a federally funded program through the hospital that I may be eligible for. It took alot of calling to find about it - they don't like to volunteer the information. It is based on your income - which at this point is zero - they said that I should qualify for it. It will pay for all of or part of the hospital expenses but most of all - it will allow me to be admitted and have my surgery. I'm trying not to get my hopes up - I've been dealing with this since December - but I want to get this done so badly.
I will have an answer in 7 - 10 days so please pray that it all works out.
Thank you again. I don't know what I would do without this site. You girls are wonderful and I have met so many good people here.

's to all.
Tammy
  #10  
Unread 03-30-2005, 11:43 AM
Insurance denied - now what???

That is great news!

I will keep you in my thoughts and prayers that everything goes as planned and you get the surgery out of the way.
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