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insurance denied surgery insurance denied surgery

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Unread 10-18-2011, 05:06 PM
insurance denied surgery

My pre-op is tomorrow, and the nurse called today to say that the insurance company did not approve my hysterectomy. She asked that person's supervisor to take a look, and to fast-track it, but who knows? She said she never imagined in her wildest dreams that they would do this.

If I go to my pre-op tomorrow, I bet they won't pay for it because they didn't approve what it's for. If I don't go, and then they do approve it, I would have to try to get another doctor to give me the pre-op. I can't believe this is happening.

My employer pays a lot of money for this insurance because it covers so much. Until today, I guess. I'm feeling just cynical enough to wonder: are they trying to delay it so that it will happen in 2012, when my deductible starts over again?
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Unread 10-18-2011, 05:23 PM
Re: insurance denied surgery

Sorry to hear of the red tape you have encountered. I would suggest contacting the person who handles insurance at your company; they take great pride in the benefits they secure for their team and might be able to help expedite things.

Good luck!
Unread 10-18-2011, 05:34 PM
Re: insurance denied surgery

Having worked with insurance companies before, I can tell you, it's not uncommon for them to deny initial requests. You may have to pick up the phone and call yourself. Tell them your scheduled appointments and let them hear from you about your medical needs. I've had to contact our State Insurance Board and file a complaint before in order to get medical care that my doctors said I needed.
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Unread 10-18-2011, 06:15 PM
Re: insurance denied surgery

Will do both tomorrow. Thanks for the tips.
Unread 10-18-2011, 08:34 PM
Re: insurance denied surgery

I'm going through a similar thing. Phone calls from my doctor and me didn't have any effect. I'm going on my third written appeal.

I really, really hope that no one ever has to go through this. We need to be fighting for our health: we shouldn't have to be fighting our "health" insurance company.

I'm rooting for you! Good luck!
Unread 10-19-2011, 05:56 AM
Re: insurance denied surgery

What type of insurance do you have..HMO, PPO? I was wondering whether a referral was initially submitted by your doctor's office to the insurance company for pre-approval of your hysterectomy. All of the approvals should have been secured before the doctor's office scheduled your appointments. I am so sorry to hear you are in this bind when you are so close. Your doctor may be able to facilitate this by convincing your insurer that your procedure is medically necessary and supplying them with supporting documentation. Also, I advise that you continue with the appeal process, the denial may be overturned. I really hope it works out for you.
Unread 10-19-2011, 06:49 AM
Re: insurance denied surgery

I agree with astrana. My doctor does not accept insurance but did all the neccessary paperwork for approvals prior to my surgery. Maybe the insurance company lost track of your doctor's request. A call is definately in order.
Unread 10-19-2011, 02:54 PM
Re: insurance denied surgery

I called the insurance company this morning, and she said the claim is pending. Not denied. Apparently the doctor's office didn't even submit it until yesterday, the 18th. With surgery scheduled for Monday, the 24th, that's not a lot of time to git'r done.

However, I saw the doctor today, and she assured me that it will be worked out in time and I will be good to go on Monday. She wasn't concerned, and told me not to worry. So I guess I'll go back to worrying about having it, instead of not having it!!!
Unread 10-19-2011, 06:39 PM
Re: insurance denied surgery

Fight it girl, if you want this and need this. Appeal the decision, but first call and find out yourself what is up. Then ask your doc office to appeal it. They may have better chance, or maybe both can. iF you get denied.
Now that i read they slacked on sending in the request its your docs fault for procrastinating. UG. Sorry I would be freaking if that happend to me. I understand.
Good luck
Unread 10-20-2011, 11:40 PM
Re: insurance denied surgery

I read this last night and panicked a bit. I'm READY for this surgery and would be terribly disappointed if it were postponed.

I called my doctor's office today and explained my concern. It was explained to me that they often don't call for pre-approval until close to the date because of frequent changes in coverage.

They called my insurance company and learned that pre-approval for hysterectomy is not required for my policy. Go figure.

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