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Surgery denied Surgery denied

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Unread 10-29-2005, 05:12 PM
Surgery denied

Has anyone had their hysterectomy denied by insurance? Mine was because it's for chronic pelvic pain. I have seen a second dr for a second opinion. He agrees with my first dr. Now we have to resubmit to insurance with the second dr's opinion. I need some encouraging words!
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Unread 10-29-2005, 05:23 PM
Surgery denied

Oh my, coming from another sister who has had chronic pain, I can't imagine how you feel having the insurance deny your hysterectomy. You pay and you pay those insurance people but they never want to give back. There should be much better laws to regulate the insurance companies. I'm so sorry you are in this situation and pray that the 2nd opinion will bring the insurance company around. It's been my experience that ins cos sometimes routinely deny claims the first time just to see if you will give up and go away. If that is the case with you then hopefully the 2nd opinion will do the trick. Good luck.
Unread 10-30-2005, 05:55 AM
Surgery denied

Best wishes, I hope that you can get it all worked out
With two drs who agree , hopefully the insurance company will reconsider.

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Unread 10-30-2005, 10:19 AM
Surgery denied


Just curious, what other kinds of treatments or tests have you tried (xrays, ultrasounds, birth control, laparoscopy...)? I was labeled with chronic pelvic pain as well as IBS and Dysmennorhia before I finally had a laparoscopy that showed endometriosis. I then tried several treatments for that before the hyst. What kind of symptoms do you have? It must be pretty bad for your doctors to want to do a hysterectomy. Unfortunately I had the opposite problem. After only one year of Lupron, birth control, and pain management, my doctor quickly recommended a hyst as well as another doctor and it was immediately approved by insurance. So far I am really regretting having had it done! Even though I am on hrt, my hormones are a mess and I have so many more problems now. Of course every woman is different so don't let me scare you. I was just wondering if maybe there are other treatments your insurance company wants you to try first? Did they say? If not, maybe you could call them and ask. Just a thought. I hope everything works out for you!
Unread 10-30-2005, 12:19 PM
Surgery denied

I had a hysteroscopy and D&C four years ago looking for a cause for my painful and long periods. There wasn't anything unusual. Then a year later I started getting functional cysts on my right ovary. The dr put my on bc to help. I was still getting cysts and having pain so she did a laparoscopy but found nothing. I switched drs and the new one put me on bc on continuous cycle - no periods. Seemed to do okay until a few months ago when I started having pain again and hot flashes and being very emotional - like I wasn't on the pill. (I also have IBS but I attribute it to not having a gallbladder - it began after that surgery.) My dr would like to do a full hysterectomy since there doesn't seem to be a specific source to the pain. I want one - to relieve the pain and because I have a somewhat higher risk of ovarian cancer since both my maternal and paternal grandmothers died of ovarian cancer. And I'm tired of going to the gyn several times every year for all of this! Insurance says I need endometriosis or fibroids or heavy bleeding as a reason for a hysterectomy. I say it's my body and a decision between my dr and myself.
I'm so glad I can voice all of this and those of you reading understand. Friends I talk to at home don't seem to understand.
Unread 10-30-2005, 04:27 PM
Surgery denied

Yes I have went through this since april finally approved on oct. 25 surgery set for Nov.8. I have been on pins and needles waiting for it to be approved now I am scared to death of the actual surgery. It is now a reality before it wasn't.
Unread 10-30-2005, 04:43 PM
Surgery denied

Good luck to klb5373 & fpswan. I had my surgery in Aug because of heavy bleeding. It was so bad I was taking 3 iron pills a day just to keep at the low end of normal. Had no problem insurance-wise. I was so tired of bleeding and feeling weak I couldn't wait until the day of surgery. For klb5373, just focus on what problems you have been going through and how that will be gone after surgery. It will make the surgery less scary.
Unread 10-30-2005, 04:52 PM
Surgery denied

Pain isn't a diagnosis. Make your doctor file your papers with an actual diagnosis; fibroids, endimetriosis, whatever you have. I know from working where I work, pain alone means nothing to anyone except the poor individual living it.
Unread 10-31-2005, 04:47 AM
Surgery denied

It'll work out....I'm sure your Doctor's office will supply the necessary documentation and it'll be approved. Keep after your doctor...and call the insurance company yourself. I called just to find out what my deductible was, etc. and got the woman talking and found out lots of interesting (if you can call it that!) stuff about our insurance plan.

The main thing is to be forceful but calm with everyone.

I'll say a prayer for you. I have chronic pain, too. And stress usually makes mine worse.
Unread 10-31-2005, 08:52 AM
been there don that

My advice is not to give up. I wrote a letter to the insurance company providing my information.
My physician was so angry that they denied the hyst that he also wrote a letter ( it was excellent).
Contact your state insurance regulator. They are a good resource. If your company that supplies the insurance is "self-insured" then the state insurance regulators are not able to intervene. In that case get to your human resource department and have them assist. Best of luck to you! I had the ruling overturned and had to wait to reschedule be I know it will be worth it.

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