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Insurance Approval? Insurance Approval?

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Unread 03-06-2007, 09:43 PM
Insurance Approval?

Hello Ladies. I was just wondering how long it took you to get your insurance to approve your surgery. I saw my Dr last Monday and he agreed that we needed to go ahead with the hysterectomy. Then he looked at my chart and said " So you have ********* insurance?" He then informed me that we would probably have to jump through hoops to get an approval from them. Told me that he just had this same situation with another patient and it took 6 months of appeals, letter writing and phone calls before they got it done!! He also said that they still made her go through other procedures before they would give approval for her surgery.

I did have a hysteroscopy and D&C for these same problems and then I tried taking progesterone for 6 months. But, none of this helped. He's afraid that they won't even look at the other things we tried because I did these 3 years ago.

I only waited this long so that my little ones would be older and so that I'd have all the money to pay my part up front. Now they may make me do it all again??

The bleeding and pain just keeps getting worse all the time. My Dr suspects adenomyosis. I can't take too much more of this. I can't even be intimate with my husband anymore because it's too painful. That exam last week still has me hurting!!

Anyway, sorry to rant. I just haven't heard anything about my insurance yet and I was wondering if I am asking for too much too soon. Does it take longer to get an approval/denial?
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Unread 03-06-2007, 09:55 PM
Insurance Approval?

Iwas suppose to have my Hystrectomy on Feb 12th but at my Pre-Op, the week before mind you they would not approve it. So on Feb12th I had to have a Diagnostic Lap a D&C and a Hysterscopy instead. After those procedures and results my insurance aproved me for April 9th. I was crushes and now I am healing from complications from those procedures and medicines from then too, just to turn around and have Major Surgery in April. And now I am run a fever of anywhere between 99.2 to 101.1 depending on when I take my temp! I am sick of being sick.
Unread 03-06-2007, 09:56 PM
Insurance Approval?

I got approved very quick it was only a few days. The only procedure I had prior to surgery was an endometrial bx. When it comes to getting insurance approved it's how your doctor words it. Make sure you stay on top of this so you will have your surgery.
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Unread 03-06-2007, 10:00 PM
Insurance Approval?

Why do these companies make us go through more and more? If a qualified Dr says this is what you need then why not listen? My Dr is now actually Chief of Staff at the best hospital in our area!! I feel great about that!! I wish my insurance would take his reputation into account.
Unread 03-07-2007, 07:39 AM
Insurance Approval?

I agree with you about the insurance companies. I just learned at my pre admission Fri. that our insurance company has approved me for same day surgery (scheduled for LAVH). The nurse at the hospital, and the nurse at the doctor's office, both explained that is how most of the ins companies do it now, and then have it changed once the doctor calls when the patient is in recovery. Seems crazy to me, and adds more stress and worry on the patient. They acted like it was no big deal....but of course....I have visions of being stuck out in a hallway tomorrow afternoon instead of geting in a room....

Ten years ago, we had to fight another insurance company for me to go out of network when I found a surgeon that could perform a minimumally invasive surgery that meant fewer days in the hospital, quicker recover, etc. The key for us was to by pass the people that initially answer the calls, and keep asking for their supervisors. We also had my doctor's support. That, along with my husband's persistence and mention of having our "legal counsel" contacting them, got them to approve what was actually logical!
Good luck, and don't give up! You and your doctor know what is right for your health, and you need to insist on it!
Unread 03-07-2007, 08:40 AM
Insurance Approval?

My insurance company was very quick to approve mine. I left the dr's office to talk with my DH over lunch about it and when I called back within 3 hours, they already had my insurance approve and scheduled me hyst for 10 days later! I guess I was one of the lucky ones.
Unread 03-07-2007, 08:48 AM
Insurance Approval?

It sounds like you have tried alot of different things to improve your situation. Many insurance companys will not approve until several things have been attempted. Hang in there and try not to project. If they do give you trouble, remember the "squeaky wheel gets the oil".

Also, most hospitals are set up for a 23 hr stay for outpatient. I had a lap hyst at 12pm and was in my room by 4:30pm. By 9pm I was ready to go. I was passing urine, my pain was managable, the nursing staff left alot to be desired, so I requested to be discharged. I have been lucky. No complications, just minor nuisances.

Good luck and let us know how everything goes.

Unread 03-07-2007, 12:47 PM
Insurance Approval?

I got approval very fast. My doctor is heavily scheduled and I wont have surgery until April 26. But, I wanted a certain hospital..... and my special day..... and some things I caused a delay with. But, the insurance company, just a few days for approval.
Years ago a doctor was telling me a delay was due to my insurance company stalling and being uncooperative and so I called them directly and it was then I learned that in that case it was in fact the doctor's office that was being difficult and not the company. I have actually found this to be so on a number of my cases. I have gone to the doctor and asked to see the fax confirmations and phone log to find that in fact a doctor's staff member was lying to the doctor and me. I have found my insurance company to be very quick to reply and diligent when dealing with us insured. So don’t be afraid to follow up and check for yourself. If it sounds unreasonable, it just may be. Regrettably a lot of folks seem to be more skilled in finger pointing than problem solving.
Unread 03-07-2007, 12:55 PM
Insurance Approval?

I called my Dr's office today and they said that they still don't have approval but the lady that handles all that said that she thinks in my case she won't have a problem. I have tried other remedies and she has a good relationship with a few people she deals with at my insurance company. So, hopefully, it will be OK. I am tentatively scheduled for May 9 at 11 am. I was hoping it would be sooner but, she says my Dr only operates 2 weeks a month. There are 7 Dr's in this practice and they share the reserved O.R. time. I hope I heal quickly!! I have one trip (girls weekend) scheduled for June 28 and our family beach vacation in mid July. The first one is a horseback riding vacation. I hope 7 weeks is long enough!!

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