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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 12-31-2005, 10:55 AM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

(((Sonya))), I am so sorry you have the extra worry about whether or not your insurance company is going to come through for you or not.

I hope by getting your doctor involved this will get straightened out. Maybe there was an error in codes used or some other simple explanation for why your precertification has been denied. Your doctor should be able to provide the necessary documentation to get your certification processed.

I know it can be difficult dealing with insurance companies. I've had my share of discussions with them and have found that remaining calm, factual and rational goes a long way toward getting the help I need.

I'm sending tons of extra s and hope that Tuesday brings you good news!

(((Sisters))), let's all try to be supportive in a positive way!
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Unread 12-31-2005, 12:27 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

I am sorry you are having to deal with this at the last minute. Having worked the physician's office end of insurance, if they have received notification of denial, they have probably already begun the appeal. Your first call on Tuesday should be to the Dr's office to find out if they have received the denial and if they have started the appeal. If they have not, ask them to. There should be the name of the person they should contact on the denial letter. Many times, more information is what is needed.

Your insurance company probably has a website. This weekend, you could search their site for information on appeals. This would get you a headstart for Tuesday.

Remember, the person on the other end of the phone is the messenger. They are doing their job and don't make the decisions. You can ask for a supervisor if need be.

The person making the decision here is a doctor and bases the decision on the information received from your doctor. Sometimes they will ask for more information which your doctor can provide.

As far as insurance, an insurance company has contracted with either an employer or member for coverage. They are paying benefits according to that contract. If you have problems with the coverage, it is your employer you need to be talking with. It usually comes down to how much one is willing to pay in premiums for their coverage. The more coverage, the higher the premium which can translate to less pay.

Now, try to enjoy this holiday weekend and put this on your do do list first thing Tuesday since there is nothing that can be done until then. I know it is easier said than done.

Unread 12-31-2005, 01:22 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Hi Tweetiebird,
I am sooo sory that you have to find out this information so close to your surgery. I agree with all the sisters. It was probably denied for lack of medical information to justify the insurances medical criteria for your hysterectomy. I work in large multi-specialty clinic and have to precert these surgeries all the time for my physicians. I am not a nurse or anything and can only go by what the physician dictates in the patients chart. Some of the criteria we usually provide are: Heavy bleeding with large clots,soiling of linen,bleeding every 2wks or 3wks,pelvic pain,painful periods,pelvic ulrasounds with uterus sizes of 10weeks or more or uterine fibroids ,anemic,low hemacrit and hemoglobin counts,pap smear results,any other tests that were done,etc.........If it gets denied by the insurance company, I notify the doctor's nurse that it was denied and then give the phone number the DR can call the Insurance Medical Director to appeal or give any additional information that Dr may left out of the chart. Insurances give a certain no. of days for your Dr to call to try and overturn the denial. I would definitely either call the on call phone no. for your DR and have them leave a message for them to call you first thing Tuesday morning about your surgery or start calling Dr. on Tuesday morning and get some answers. I know I was stressing when my surgery was near. Hurrican Katrina was coming and I didn't know if I was going to have to cancel my surgery. The hurricane hit a week and a half before my surgery. I didn't know if the hospital was going to be able to the surgery because our city had double in size after the hurriance. My medical leave papers were already done and I made arrangements with my job,daycare,etc....I was worried but it turned out alright. So keep your chin up and try to be positive on your outcome. I wish you luck this upcoming week and try not to let it get you down. Heres a great big hug from one of your sisters. Our prayers are with you. Love, Carrie
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Unread 12-31-2005, 02:15 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

I agree with the prior poster, the report your doctor wrote is probably insufficient in the description of your case.

I think, because the cost of the surgery is high and insurance companies want to keep costs down, they will not allow a hysterectomy (partial or full) if there is no medical evidence of an issue that is impairing the persons quality of life, or threatening their life.

I know when I was in the hospital, I wanted to stay one more day and the doc said, insurance companies only approve 3 days. If I stayed another day, it would be on my dime. They push you fast out the door, cheaper for them. People say, it;s good to get out of the hospital quick because there are germs to avoid, and people are sick, but ya know - I really could have used one more day.

Insurance companies are a pain. And they are sure very tough when it comes to disability claims. They cross every T and dot every I.

I have not received my first disability check yet. They take a while. Sometimes your first check comes when you return to work. stinks.
Unread 12-31-2005, 02:29 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Darend, I am sorry about your disability check.Some disability policies make you use at least 40 or 80hrs of accrued vacation(PTO) time before your disability checks will kick in. That was my case. I received my checks on the same day I would have received my regular paycheck from my job. Fortunately, I only live 2 miles from my work and my boss brought me my first disability check to my house. But I had to pick up the other 2 checks myself at my job. I hope you get some funds soon even though mine was only 60% of my paycheck. Every little bit helps. Take Care of yourself. Carrie
Unread 12-31-2005, 03:39 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Thank you guys for everything.
The thing is I am also doubled up on insurance. I have went through a very nasty divorce and thru the process my ex husband filed bankruptcy, on everything, including doctors. So my kids and I were able to receive a medical card. So I am still on his insurance and medical card. From my understanding, they did not pre-cert medical card, was only going through first insurance.
Yes, I have to wait until Tuesday morning when everyone is back in. Wed. is suppose to be surgery day. I am thinking in my heart it is not going to happen. Then again, I think it is.
Do I pack a bag or not pack a bag the question is.

Happy New Year Everyone!

Unread 12-31-2005, 05:41 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Hi Sonya!
I will say a prayer for you! This is the last thing you need to be thinking about. I'm sorry this is going on right now. Just like the other ladies said, get on the phone first thing tuesday a.m.
Wishing You All the Best,
Unread 01-01-2006, 05:28 PM
5 Days To Go And The Insurance Company Wants To Deny My Surgery

Tweetie bird- thinking of you the last few days with your dilema...best wishes. Call both your MD and Ins and if the phone rep at your ins co you get on first shot does not seem to be responding and escalating your need fast enough...do ask for a supervisor..and also do not hesitiate to request that the ins co get in touch with your Dr for you to get EXACTLY what is needed...also ask that this problem go VIP to the medical director to get final determination and an answer...give them a reasonable time frame..(4 hrs)... to get back to you.

GOOD LUCK! You are in my thoughts.
Unread 01-02-2006, 03:37 PM


My thoughts are with you. I hope everything got taken care of today. Please let us know if you can what happened today. I am sure there are plenty sisters on here that are worried about you.

Unread 01-03-2006, 12:05 PM
Total Hysterectomy scheduled as planned on 1/4/2006

Hello everyone

Long weekend. Fighting with insurance companies should not be. They sometimes need to listen to our doctors who have treated us and know our bodies like we do.
After all the bologna that has took place since the end of last week, my surgery is going to take place tomorrow morning.
I have been very sick. I can not keep nothing down, throwing up about every 2 hours and a headache that is so bad it is making me dizzy. I have been so sick. Told my doctor, she said as long as I can try and keep some fluids in me we should be ok.
Will be thinking of everyone and let you know when I return home.

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