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5 Days To Go And The Insurance Company Wants To Deny My Surgery 5 Days To Go And The Insurance Company Wants To Deny My Surgery

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Unread 12-30-2005, 03:21 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Hello everyone.
I am now just getting off the telephone with the hospital and they have told me that the insurance company will not pre-cert my surgery. Said they do not have enough information for them to grant the surgery. Said there is no reasons to have it done. I would say with many ultra sounds, 3 hospital stays and many medications this past year, what does a insurance company want.
I am offically on medical leave, have trained someone for my job, and have everything in place for the long haul and now this.
I will now not know nothing until Tuesday on what is going on because of the Holiday. Scheduled for surgery Wed. So I would say that Tuesday is going to be a crazy day to find out what is going on.
I should of known that this would be a fitting end to a very hard long year. How much can one person take. I thought my nerves were kicking in, now they are really kicking in and I am now scared because it is something that I really need to get me back on my feet.
What a long weekend and a long weekend to worry about what is to come. This is truely the unknown for me right now.
So ladies, I am sick to my stomach, scared, and really do not know what to say or do at this point.

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Unread 12-30-2005, 03:28 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Can you call your dr's office and see if they can get the ball rolling? It is amazing what a dr can accomplish sometimes, they know how what to do to get the insurance to accept most things. Best wishes.
Unread 12-30-2005, 03:31 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Doctors are closed until Tuesday. This really stinks. It had been a long hard year anyways and now this. My emotions are running high along with anything else you can think of. What a way to end the year.
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Unread 12-30-2005, 03:39 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Hi Tweetiebird,

I agree with Weiser. From the replies I have read on Hyster Sisters, it does seem like a Dr. has a lot of say especially in the ~wording~ of why a hyst is needed. You said your Dr's office is closed on Monday and maybe you can reach him out of the office through his answering service. I mean an answering service is usually for an emergency only and this sounds like an emergency for ~you~ since your hyst is on Wed. You don't need to be worrying about this until Tues.

Best wishes,

Unread 12-30-2005, 04:08 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Hang in there! Take deep breaths. I'm praying everything is going to work out for you.

I, too, remember my doctor saying that she was going to have to present my long history of problems, including what was done by my previous Gyn, to my insurance company. It may be due to the way your doctor did or did not present your case.

Good luck and keep us posted.
Unread 12-30-2005, 04:16 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

My insurance co. tried to deny my surgery, also. My dr. wrote them a sharply-worded letter which included a reminder that the last hysterectomy they tried to deny turned out to be cancer. She basically asked them if they wanted to take that chance. Good thing they approved the surgery because one ovary was attached to my intestines and pulling! I can't believe they are still haggling over this when your surgery is Wednesday. I would definitely call the on-call dr. and let them know of the situation. Your dr. needs to be pro-active on your behalf this weekend . I'll be praying that this works out for you. It's bad enough to be worried about this but to have a big question mark about whether it's going to happen or not is terrible. (I had to plan for 3 weeks of substitutes for my Kindergarten class and it was a tremendous amount of work! I understand getting your job prepped for your absence.) Wishing you peace this weekend and a stress-free surgery on Wednesday!
Unread 12-30-2005, 04:57 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Worse case scenario, even if the insurance company doesn't approve it, make a contract to pay $10 a week for sevices rendered. They can't do anything to you as long as you pay them something. Good luck.
Unread 12-30-2005, 10:56 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Hang in there! My first two surgery dates got postponed because of the stupid insurance company, and it finally got approved two days before the third date! My doc said they usually automatically deny the surgery request on the first try, but once you appeal it they usually automatically approve it. This was just his experience with this particular insurance <oops! no insurance company names, please>, but I wouldn't be suprised if this is what other companies do too. If a company automatically denies 100 requests, maybe some people would not pursue it and they would then only have to approve 95 (totally making up statistics just as an example). By not doing those five that were initially requested, the insurance company saves a lot of money.

First thing Tuesday morning start making phone calls. First call the doctor's office to find out who is going to be working on this for you. Someone in the office is usually doing all the pre-authorizations, and when your denial came in there was a name and a phone number with it. Get the MD office to call there, and then you call them too. Nag them all day until you get the answer you want. Stress to the insurance company that surgery is already scheduled, and unless they want to risk lawsuits from malpractice for delaying your care, they had better approve it.

Good luck. I know it ***** that people without medical training are the ones who make decisions that affect our lives. Ugh!
Unread 12-30-2005, 11:31 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Thank you for all the comments and suggestions. Worked on this all afternoon, and everyone is out for the holiday until Tuesday. So I am in a frenzy of not knowing what to do. I am on medical leave and do not even know what is going to happen Tuesday. This was a very heartfelt decision, probably just like everyone else. Especially after you make that decision, you learn to accept and know what is going to happen. My mind is blank and I can not sleep. I am very tired of all the bologna from everything.
Unread 12-31-2005, 08:32 AM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Just for the record:
when an insurance company denies a surgical proc it is most likely beacuse the MDs information did not present your case and specify the way and why you meet the criteria. These criteria for surgical proc are pretty standard from company to company. Most MDs know how to do this effectively and efficiently. Also for the record...non-medical folks do not deny a procedure. All denials must be made by a physician at the insurance co. That is the law. Make sure YOUR Dr. presents your case properly. If there is not enough info to approve--- it probably means the Dr. left something out of the information sent in. Remember these are often sent in by office staff...who may have gotten soemthing in the "send" pile before it was really ready to go...most errors are honest human mistakes. Dr should be monitoring his/her staff for completeness and accuracy though. Too many denials in an office practice for incomplete info probably means an office problem...Dr needs to fix that!

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