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Denied over night stay after surgery Denied over night stay after surgery

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Unread 11-29-2011, 05:00 PM
Denied over night stay after surgery

Has anyone been sent home the same day of their hysteretomy. My Insurance company denied over night stay. Said the procedure is considered outpatient. This is crazy!
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Unread 11-29-2011, 05:04 PM
Re: Denied over night stay after surgery

That doesn't sound right at all. Surely someone else could comment on this with more information than I can. But if my insurance co said that, I'd be on the phone with the doctors office who would be on the phone with my insurance company.

I would imagine they would be paying more for sending their patients home after this surgery because of complications than allowing them a couple nights stay in the hospital.
Unread 11-29-2011, 05:18 PM
Re: Denied over night stay after surgery

thats odd....even the dr could order a 23 hour observation instead of 24 hour...sounds like the drive thru massectomy...antother way for ins co to save money. Senseless. I am so sorry. So much could happen! It is a serious surgery! On my gah!
I wish I could hug you! I certainly hope there are no complications!
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Unread 11-29-2011, 05:25 PM
Re: Denied over night stay after surgery

Often they consider 23 hrs from when you come out of OR to be "same day", even though it's in fact, overnight. Ask your ins and Dr about that. Generally if the Dr says there's a need to stay, the ins does cover that at the time. I know my BSO was approved as day surgery, but I had to stay over due to a couple reasons, and it was covered. Check with your Dr. I know sometimes it is day surgery, but I don't think that's best for everyone. Best wishes for an easy surgery.
Unread 11-29-2011, 05:37 PM
Re: Denied over night stay after surgery

I stayed two nights, but I have a very expensive PPO plan.
I would think that one night would be the minimum.
Unread 11-29-2011, 07:38 PM
Re: Denied over night stay after surgery

Actually, many surgeries, hysterectomies included, are being done on an outpatient basis for a number of reasons, not all of them relating to insurance companies.

As mentioned early, as long as a patient is released within 23 hours, it can be considered outpatient surgery. In my case, the 23 hours for my last surgery did not start until I was moved from Recovery to a room so a planned overnight stay was included.

If you have concerns, talk to your doctor. If you are not physically ready to be released, your doctor will know how to get an extended stay covered. Trust me, my insurance company had not pre-approved the 10 day stay I had with my hysterectomy but they had no issue covering it when my doctor deemed it necessary.

Unread 11-29-2011, 08:13 PM
Re: Denied over night stay after surgery

I had a LAVH at 11 a.m. and was home by 4:00 with pain meds in hand. Most insurance companies will deny it as it is considered an outpatient procedure (23 hours) but once there is deemed necessary and you have to stay longer they shouldn't have a problem with it. Talk to your Dr about what happens if you need to stay or if you feel you would be better off staying a night. They have ways to get it approved once you are there. Good luck.

Unread 11-30-2011, 07:13 AM
Re: Denied over night stay after surgery

As the other (((sisters))) have said, you may or may not need to stay in the hospital overnight, but the doc can get whatever is needed approved.

When I had my surgery, I called ahead because (like you) I wanted to know just what would be covered. The nice woman at the insurance company said, "You have 365 days per year of hospitalization coverage." I said, "Huh?" I just want to know how long I'm approved to stay after surgery." She said, "365 days per year." I was still confused, so she said, "We don't give you a cut-and-dried answer. It's up to the doctor as to how long you stay in the hospital." She went on to say that, given the procedures I was having, most patients are in for 2-4 nights. I was in for 3 nights.
Unread 12-01-2011, 11:03 PM
Re: Denied over night stay after surgery

I stayed for two nights after my surgery. I think it's a medical decision whether you stay. If your doctor says its necessary, it should be covered.
Unread 12-02-2011, 12:34 AM
Re: Denied over night stay after surgery

That's horrifying. I can't believe your insurance company would do that. I think they'd be more afraid of the risk of complication.

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