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Insurance Denial (Updated) Insurance Denial (Updated)

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Unread 09-21-2011, 04:55 PM
Insurance Denial (Updated)

I am so upset today that I cant even think straight. Yesterday I got a call from the nurse at my doctors office informing me my hysterectomy was denied by my insurance company. I am in total disbelief. I am a full time student, as well as the many other hats I hold. I have planned and scheduled for everything, my dh even took a week off to help me. My hysterectomy was scheduled for Oct 19, now I dont know what is going to happen. I have an appointment to see my dr on Monday. I really do not want this put off anylonger. I dont want to deal with the pain, bleeding, fatigue, bathroom issues and all that comes with these fibroids. Has anyone else had problems with insurance saying its not medically necessary even though the doctor who is caring for me says it is. What should I do?
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Unread 09-21-2011, 05:21 PM
Re: Insurance Denial

You can appeal the decision and have your doctor write and explain why you need it. Someone in the doctors office should help you through the appeals process.
Unread 09-22-2011, 01:54 PM
Re: Insurance Denial

I haven't been in your situation...yet. But I'm nervous that I might be. My doctor told me that if they initially get a denial, there are many avenues she can take to change thier minds. She told me that often, all it takes is a phone call from her or filing an appeal form (also done by them), and insurance will reverse their decision. I have heard from other women that if you get a denial, you should find out from your doctor what s/he is doing on your behalf, and also ask your doctor what YOU can do as far as contacting your insurance company.

I have horrible luck, so I'm convinced that my insurance is going to deny me initially. Still waiting on a decision. Luckily, my doctor doesn't schedule the surgery until they get approval from insurance, so at least I'm not having to cancel plans.

I'm so sorry you're going through this!!
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Unread 09-22-2011, 02:03 PM
Re: Insurance Denial

I'm so sorry you are going through this. I have never dealt with anything like this before so I have no advice but just want to wish you well! I hope your doctor can help you appeal this!!
Unread 09-22-2011, 02:25 PM
Re: Insurance Denial

Yes, write an appeal! My insurance surprisingly didn't need a pre-auth, but take proactive steps for what you want.
Unread 09-24-2011, 08:21 PM
Re: Insurance Denial

Thank you for the advice. I have an appointment with my dr on Monday afternoon. I will keep you posted.
Unread 09-24-2011, 10:51 PM
Re: Insurance Denial

I will pray for you. I am soooo sorry. I have been sitting here worried about the same thing. Because I have state insurnace becuase I am not working and not making money basically so they could very well deny me, it has to be a medical neccessity. The Scheduler made it sound very easy when i asked her if she had to get a prio authorization and wait for 30days or something. She said no all I have to do is send ina paper.
SO I pray all the time. I litterally cannot work and as of right now am trying not to end up in hospital due to pain today.
Good luck to you. Fight it all you can, deny it and mostly try have your gyn deny it also.
Unread 09-27-2011, 07:59 AM
Re: Insurance Denial

I have spent all night crying and have a massive headache after the dr appt. The hysterectomy is off and I need to try another form of treatment. Not at all what I wanted to hear. Hormone is off the table because I am an emotional rollercoaster with them. He suggested an ablasion. I dont know what to do. I am miserable.
Unread 09-27-2011, 08:11 AM
Re: Insurance Denial

I feel your pain and manu hugs! The same thing happened to me! The day of my pre-op, I got a call from the nurse that my insurance denied it! I spent all day arguing with them and had to cancel my surgery. It mad e me mad cause i planned it so no school worries and demands form the kids! I had to write an appeal letter and get my doc to do the same, so annoying! I am 37 and i think it was my age that got or or perhaps the doc did not write a good explantion. I had adenoyosis! After, I sent it in 2 weeks alter i got approved for it! Thie ris hope and do not give up faith! I could not get it done till 8-10 due to scheduling conflicts wiht my doc! Do not give up!!!
Unread 09-27-2011, 09:31 AM
Re: Insurance Denial

There is hope. Have your doctor automatically appeal the decision. Also, call your insurance company and ask what YOU can do to appeal.

I'm sure I'll be going through this same thing very soon.

Best wishes!

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