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Insurance Approval Insurance Approval

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  #1  
Unread 11-13-2006, 03:54 PM
Insurance Approval

As if we females didn't have enough problems as it is - this business about the insurance companies denying approval is really upsetting me. Now, I'm getting worried that my surgery won't happen and I'll have to continue to live in agony, which won't be too long because I can't take much more. Has anyone out there had a similar diagnosis as me? I have fibroids. Last spring my gyn said my uterus was the size of 13 wks. I'm sure it's bigger now! My periods are unreal, last 10-12 days, with 3-4 of those days extremely heavy flow. This may sound gross, but I soak a super plus tampon and a super pad in 45 min to an hour. I am an RN on my feet all day so this also affects my job. There is no need for the ablation thing to be done as I am 47 and do not need nor want to preserve my uterus! Does this sound like enough stuff for the insurance OK or do you think they will say try some less drastic measure before hysterectomy?
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  #2  
Unread 11-13-2006, 04:21 PM
Insurance Approval

It sounds like this is really weighing heavily on you.

At this point, I wouldn't worry about it. I was really worried about it, too -- mostly because of what I had read here at HS about the difficulty of approval. When I was finally scheduled, I called my insurance company for a pre-authorization for how long I could stay in the hospital. I was thinking she'd grill me about why I was having the surgery, etc. All she said was, "You have coverage for 365 days a year." I asked what that meant, and she said I could stay as long as the doctor said I should stay. I asked about the hysterectomy, and she said as long as it was being recommended by my doctor it would be covered. But that's not how every company operates.

So it will depend on your particular insurance company -- try not to worry about what hasn't happened yet. (By contrast, my insurance company would not cover the panniculectomy I had done along with my hyst, even though it was not cosmetic but being done to facilitate healing. Go figure. )
  #3  
Unread 11-13-2006, 06:43 PM
Insurance Approval

My dr called and got mine approved. I had no trouble at all with it, I have <oops! no names of insurance companies please!>. I have fibroids, an enlarged uterus, and a cervical polyp.
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  #4  
Unread 11-13-2006, 06:53 PM
Insurance Approval

I had no problems with having my hyst approved by insurance. But I had had a diagnostic lap, hysteroscopy, & D&C prior to my hyst.

Some insurance companies do have more hoops to jump through, but no need to cross that bring until you come to it.

Best wishes to you and try not to worry!
  #5  
Unread 11-13-2006, 07:15 PM
Insurance Approval

You know, I didn't any procedure like D&C or myomectomy before my hysterectomy, but my doctor did document the fibroid growth with about 3 ultrasounds, and I wonder if that did the trick with my insurance company, which is sometimes pretty stinky about things, but they okayed my surgery with no problems. I hope you will experience the same.
  #6  
Unread 11-13-2006, 07:49 PM
Insurance Approval

I don't believe you can have an ablation with a uterus that size. It probably won't work even if the dr. tries.

I hope you get approved for your hyst.
  #7  
Unread 11-13-2006, 10:54 PM
Insurance Approval

I did not have any objections from my insurance company. I went to my General Practitioner with complaints of prolonged periods that were also very heavy for several days. She did a standard exam and thought that my uterus felt thick. So she sent me for an ultra sound. The result was inconclusive. They saw "something" but were not sure what it was, so she refered me to a GYN.

My GYN had an ultrasound done in her office, she sat along side me to see what was up and diagnosed two fibroids. They were inside the uterine wall.

I had three options....medications to try to shrink the fibroids; doing nothing; or hysterectomy.

This entire process took about 3 weeks and surgery was scheduled. Surgery happened two months later and my insurance carrier paid all but, approx, $1,000.

I feel very fortunate to have the coverage I do...and at the cost I pay. I pay $52 a month for medical, dental and optical, my company pays the rest. Very fortunate.
  #8  
Unread 11-14-2006, 02:39 AM
Insurance Approval

You know being one of the sisters who got denied I have to post to this thread. With me they found I had 1 fibroid that they said was a little on the large size but nothing as big as some of our sisters. Some endo and insane periods (I can so relate the super plus in less then an hour).

They did turn me down however, one appeal (which was only needed because of the lack of information) and I am on my way to surgery. I would try not to worry about it too much (which I know it much easier said then done) until they say you where denied. And, then still try to relax because many of us who have been denied and are/have still have gotten the surgery just with a few extra hoops to jump through.

So hang in there and have faith it will all work out. And yes, I know this is easy for me to say now that I am not the one flipping out but, really it normally all works out for most sisters. I bet if they did a poll over 90% of those who have been turned down where able to get the surgery in the end. IMO anyway.

So hang in there and try to relax!


Mystik
  #9  
Unread 11-14-2006, 04:12 AM
Insurance Approval

Thanks for all your responses. I do feel somewhat better about the insurance issue. Last night I had a hard time falling asleep(I also have restless leg syndrome from anemia.) Anyway as I lay awake thinking of my life and how truly amazingly blessed I have been, I thought about how things really always work out for the best. So, I am putting it all in God's hands and He will take care of it. If it is meant for me to have the surgery, the insurance company will approve it. If not, then plan B or even plan C will happen. But in the meantime I am praying that my surgery gets scheduled right away, the insurance co gives the green light, I'll never have another period, and I will feel better in record time! I'll know something tomorrow.
  #10  
Unread 11-14-2006, 04:54 AM
Insurance Approval

If I may ask. What type of insurance is it? I did insurance billing for 13 years.
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