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Question about medical terminology Question about medical terminology

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  #1  
Unread 05-30-2008, 12:31 AM
Question about medical terminology

On May 6 I had an LSH with my left ovary removed. I am confused now because I just got a letter from my insurance company denying a claim from a doc that I haven't even heard of (it appears he has a similar address as my gyn so I assume they worked together on the surgery). In any case, the primary service description that they are denying is "cystourethroscopy with insertion of urethral stent." Does anyone know exactly what this means, and why insurance might deny this claim? From the explanation of benefits from my insurance company, it does not appear that I am responsible for these charges (knock on wood), but I am still a bit confused about the procedure. Plus, I am not sure if I should go ahead and file a grievance if the explanation of benefits says I'm not responsible. I just don't want to miss the deadline for filing a grievance and then find out that I have to pay! Any info would be greatly appreciated.
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  #2  
Unread 05-30-2008, 06:06 AM
Question about medical terminology

it could just be a billing error. it sounds like some kind of scope involving your urethra and a stent was put in. were you aware of any work like that being done with your urethra or bladder? the easiest thing to do is just call your surgeons office and check and see if that procedure was done during your surgery.
  #3  
Unread 05-30-2008, 06:20 AM
Question about medical terminology

My LSH was on 5/19 but haven't seen any EOBs (Explanation Of Benefits) yet. I work in an insurance agency in Employee Benefits - we are the broker for group benefits including major medical and provide customer service (including the research of denied claims) for the employees of those groups.

I'm not sure what state you are in, but here in PA there are several reasons why a claim can be denied. It could be that the provider is not a participating provider; it could be that there is additional documentation required for the claim to be approved/paid; it could be an incorrect diagnosis code or procedure code entered; it could be something that required prior approval and is in a denied status until it gets through the approval process; ...it could be so many things that could cause the denial and it doesn't mean it will not eventually be covered. It also depends on the state you are in - I'm only familiar with and licensed for the state of PA. Insurance can be confusing and errors can be made - ALWAYS QUESTION ANYTHING THAT DOESN'T APPEAR CORRECT ON THE EOB. The EOB is your opportunity to catch any errors with your claim.

I would call the number on the back of your benefit card. They should be able to tell you exactly why it was denied so you can determine appropriate action, if any is needed.

Good Luck and please keep me posted with your claim!
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  #4  
Unread 05-30-2008, 10:24 AM
Question about medical terminology

I had that when I had my BSO in July. I have alot of adhesions and he put stents in so he knew where my uterers were so he didnt knick them.
  #5  
Unread 05-30-2008, 10:49 AM
Question about medical terminology

Thanks for the input girls. I just talked to the girl at the doc's office - she got my chart and said that they did the stent along with the hys. My question is why would they do that without ever talking to me about it? They didn't say anything about it before, or even after. I didn't know until I got the insurance paperwork. I have a very painful bladder disease (interstitial cystitis), and it seems like the stent might not be a very good option in my case. Is this supposed to be removed at some point? I already had my follow-up appointment - he said that everything went great and didn't have anything else to say about the surgery. At this point I'm not ever scheduled to see him again (he's not my regular doc). Does it seem strange that this would not have been mentioned to me???
  #6  
Unread 05-30-2008, 11:50 AM
Question about medical terminology

Did you have your surgery with the DaVinci Robot or laparoscopically? I was told they would scope me and place stents in the ureters before doing the actual hysterectomy so theywould know where they were located and wouldn't nick them during the surgery.
  #7  
Unread 05-30-2008, 01:00 PM
Question about medical terminology

when i had my tubal and they ended up taking out my appendix, the insurance co didnt want to cover the appendix at first because it wasnt "the original plan" so once they got the whole story from all the involved Doc's everything was covered.
  #8  
Unread 05-30-2008, 02:17 PM
Question about medical terminology

The surgery was done laparoscopically. I talked to the doctor's office again and asked again about the stent - if it was just there for the surgery, if it would need to be removed, etc. She said that it is there for good...????? My surgeon is now in surgery - but even if he does call back himself, I can't imagine I will get a satisfactory answer. He has a super deep accent, and on top of that is the type that says that everything is great, I should be back to all normal activities now (2+ weeks later), no pain, ovary (just have the right one) should be working perfectly now, etc. I question him anyway based on those responses, and now I'm really wondering about this stent thing. It would have been one thing if they had said something to me before or even after... but now I'm just left with a ton of questions, and concern that they may have done something unnecessary or even harmful to me.
  #9  
Unread 05-30-2008, 03:57 PM
Question about medical terminology

Bradox:
You are important... Now that I have said it, you must believe it.. Doctors sometimes feel like we ask too many questions, but we deserve to get a satisfactory answer..... Please do not just give up on this... If you want to know why it was done and why it will be permanent you need to ask... I find it is best to write down my questions prior to exams so I take up less time ... Then they seem willing to give me answers.
  #10  
Unread 05-30-2008, 05:00 PM
Question about medical terminology

That is very strange that they didnt even discuss it with you prior to surgery or even after for that matter especiaaly if they were leaving it in. I would be furious about this. You've never had problems with your uterers in the past? My dr told me everything he was gonna do before surgery and when he came to see me after surgery he told me everything that happened and what they found and that he removed the stents. Hope you get some clear answers for your own piece of mind.

Sherrie
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