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Insurance denied!! :(( Insurance denied!! :((

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Unread 01-19-2009, 10:32 PM
Insurance denied!! :((

I was informed today that my insurance denied me. When I asked why I was denied, the lady at the gyns office told me that the ins. told her they didn't have all the paperwork they needed. She said that they did have all the paperwork and that sometimes insurance denies the claim because they dont think the claim is serious. She said that 99 percent of the time an appeal is approved but it may take another 90 days to get it approved and schedule the surgery.

I am so frustrated with this process. I am just ready to have it all done and over with. I am tired of my back hurting. I am tired of my recurrent CINII and CINIII. I feel like I am going to have to sit and wait for this to turn into full blown invasive cancer before they will pay. UUUUUUUgggggggggg. lol

Sorry needed to vent.
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Unread 01-19-2009, 11:47 PM
Insurance denied!! :((

If you have your insurance through your work, get your work involved. Whoever is in charge of insurance there can help you appeal the decision. I was in charge of the insurance at the office and worked with the insurance broker to appeal my decision. I had an answer within two weeks.

My situation was a little different from yours because the insurance pre-approved the surgery and then refused to pay the surgeon's bill. All it took was a letter from me and the doctor's notes from my pre-operative appointment.

I was shameless when it came to complaining about the treatment I received in light of my cancer diagnosis. I can empathize with your being exhausted from the pain and the frustration.

Keep your chin up! You can succeed at this.
Unread 01-19-2009, 11:49 PM
Insurance denied!! :((

Krc- Oh sweety I am soooo sorry!!!! I think that the first thing to do would be for you to call your insurance. Make sure that the "paperwork" they need isn't just something silly. I would also see if you could stay in personal touch with the billing/insurance person at the doctor's office. I know that ins can be a pain but often it is actually human error that causes some problems and delays. I had a recent biopsy reject. When I finally got ahold of the ins they said that they had never been billed. After playing phone tag with hospital and ins we finally figured out that when they billed the ins the hospital had added an extra number to my SS# (which in turn dropped off the last number). I hope that you are able to get things taken care of. I have always felt that ins should not be able to decide what treatment or medications our doctors see fit for us to have.
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Unread 01-20-2009, 01:12 AM
Insurance denied!! :((

Thanks for your encouraging words. My insurance is <>. I don't know about everywhere, but in the state of Georgia, you are eligible for <> with pre-cancerous and cancerous cervical and breast conditions. I spoke with the surgery scheduler at the doc's office today and she said that they are going to fight it vigilantly (sp?). She said all the documentation is there and that the paperwork the insurance company is saying they didn't receive was all in the packet sent to them. Maybe they misplaced it.

It does feel good to know the doctor's office is pushing so hard to get what I want. I would be up for my third leep now and really just want to be done with it. It isn't cancer yet but it is to close for comfort. She said the appeal process could take up to 90 days but i hope it doesn't take that long.

I know it sounds weird, but I was getting kind of excited for my hysterectomy. I seem to have constant back pain and bowel issues and after reading so much on here I am almost certain it is a female issue. My uterus is tipped back and to the right.

During my ultrasound the teck said a i had a 3 cm cyst on my rt ovary. She called it a functional cyst. What is that?

Sorry so long
Unread 01-20-2009, 01:43 AM
Insurance denied!! :((

A functional cyst is a cyst that has formed because of ovulation. Either it is getting ready to release an egg or it has already released the egg and has now formed corpus luteum (which supports a preg. until the placenta takes over).

Best of luck with the ins. I hope that the doctor's office is able to get things fixed for you soon. I understand looking forward to having the hyst. Of course you would look forward to something that may ease your pain and make your life better. I hope that they are able to do the surgery soon and that it brings an end to your problems.
Unread 01-20-2009, 08:02 AM
Insurance denied!! :((

I'm sorry your surgery has been denied and I can feel your disappointment. However, I was reading your initial post in our New Member forum where you said that your doctor wanted to do another leep procedure, but it was you who pushed for the hysterectomy. You also said the ultrasound tech was going to "try her best to make my cervix appear short. She said that almost guarantees approval." Perhaps with all the paperwork before them the insurance people felt that until all options have been exhausted, a hysterectomy would not be approved.

My suggestion would be to call them yourself to find out the reason your surgery has been denied.
Unread 01-20-2009, 08:59 AM
Insurance denied!! :((

sometimes its just a matter of your dr writing a letter showing the insurance company that all other options have been tried and have not worked. or maybe your insurance feels that there are still more options your dr can try before you have such major surgery. if your dr feels this surgery is medically necessary, his office will be able to straighten this out.
Unread 01-20-2009, 01:25 PM
Insurance denied!! :((

Hi krc 117

You need to call the insurance company and find out exactly what they need. An appeal won't come in to play until they have all they need. Once you find out, call your doctor's office and let them know. It is probably all just human error. Maybe the dr has already sent all that is needed, maybe not, but unless you find out for yourself, you won't know.

I'm an insurance broker. I help people with this kind of issue every day. Sometimes the error is on the part of the insurance co. and sometimes it's ont he part of the dr's office. Ultimately, it is unlikely that the insurance company will not pay your claim.
Unread 01-20-2009, 02:21 PM
Insurance denied!! :((

I got a letter from my insurance company today. They said they didn't have any documentation of my previous leeps. I have had 2 so maybe that is the error. I have had 2 and the doc told me during my 2nd that he would do the hyst if I needed a third. Well 6 months later I needed a third but I only have 1 cm of my cervix left. The ultrasound tech didnt have to make my cervix appear short because it already is really short. I am working very closely with my gyns surgery scheduler to get the matter resolved.

According to the doc, I really don't have enough cervix left to take. So we will see what happens. Thanks for the suggestions though. I will definitely look into them and hope for the best.

I actually think God is working for me in this matter. I don't have quite enough sick and vaction time at work to cover the time I would miss and I was worried about what would happen if there were complications. Putting the surgery off another couple of months allows me to save up some more time.
Unread 01-21-2009, 08:52 AM
Insurance denied!! :((

Hiya krc,

Just read your post and sympathize greatly with your situation. I find it so difficult to comprehend the idea that on top of everything else you have to worry about at the minute, you are also burdened with the worry of how to pay for medical treatment.

There's a lot that could be said about the British government that may not be terribly complimentary but our government funded health service is
pretty darn good. Just reading your post made me take it a little less for granted. Thanks for pointing out another blessing!

My very best wishes to you in your endeavor with the insurance company. I'll check in again.

sally n mutts

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