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Insurance approval questions Insurance approval questions

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Unread 04-06-2002, 03:30 AM
Insurance approval questions

I never dreamed I might have insurance problems! I've worked for the same school district for 11 years, and the doctor's office called yesterday re: insurance--something about "pre-existing conditions" because of my hysteroscopy (D&C) last spring.

Unfortunately, the office called my poor husband at 11 AM and since he works midnights, he couldn't remember all she said and it's driving me nuts! Why don't they call me at work??? I called when I got home, but the lady had gone home--I want her job She's supposed to call me back Monday, but I want to know now!

The school did get a new insurance something in January, 2002--they said it was the same company, but just somebody different handling claims or some such thing. I can't help it if my school changed stuff, so why should it be considered that I had "pre-existing conditions" they don't want to pay for! I mean, they are still paying for expensive medications that I take for high blood pressure, and I had that before January 2002!!! That sure was "pre-existing"!!

I went back and searched about insurance and didn't see anything about insurance balking because of "pre-existing conditions". I dug out the plan book and I'm thinking that if I can prove I had "continuous coverage" before this new deal, I'll be O.K. Why does it have to be complicated? How do I "prove" continuous coverage? To tell ya the truth, I thought they might balk and want proof the hyst was needed and I was telling the Dr's office they might need to get records from previous gyn.

Part of this that's driving me nuts is that it's Saturday and I can't call anybody and just deal with it.

The other thing I don't get is that surgery is scheduled 4/29, and I have already notified my principal so she could get a sub. I have been trying to prepare stuff ahead, but it's already a huge job just getting ready to teach regularly each week, without thinking about many weeks ahead!!! Does it take long to get insurance problems resolved? We can't set up with a sub and then say, "no, we don't need you"--she could have gotten other work. And then since it's the weekend, I was going to spend it down at school making copies, getting stuff located--you don't just plan on spending 6 weeks out from 1st graders (or any grade) and expect it to "all fall together" for crying out loud, and now my motivation is all out of whack-- Like I really feel good enough to deal with all this--------

I thought I was handling this so calmly--have taken my good old time coming to the decision, etc., but this is stressing me just a tad--and then some!!!!! And to top it all off, my DH's job is in a mess right now--they're changing him to second shift (a family nightmare) with his "weekends" to Monday and Tuesday. I have to take a class on Monday's--when on earth are we ever going to see each other?

I do apologize. Yeah, I like a little cheese with my "whine" I've gone on far too much. Somewhere in all of this there are questions. Is it possible anyone can sort through and find one or two of them and have any reassurance at all? Bless you, if you do!!!
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Unread 04-06-2002, 04:22 AM
Insurance approval questions

My DR's office said it usually takes a couple of weeks to get approval. I have to have preauthorization (I think most policies require that now) so I started calling my ins co about a month before surgery, which was two weeks after the apt where I scheduled the surgery, nope nothing had been submitted yet. The ins co told me not to worry they could wait til the day of surgery.

Oh sure, don't worry, like most sisters I had to make arrangements for help, my DH had to ask for a vacation week so he could take care of our baby grandson, I picked the time frame I did because DS had a school vacation and could take a week caring for his nephew, my mom was going to fill in with childcare whenever necessary, but she would like to plan her life too. Just a little detail - NOT. And it seems like they plan it, calling on Friday, leaving a message and letting you worry all weekend.

Good luck on Monday and let us know what they tell you.
Unread 04-06-2002, 05:54 AM
Insurance approval questions

Laura, I think there is a law about pre existing conditions. I don't know if it is state or Federal. Im pretty sure it is federal. There is always ways around that too. It is all in the wording. Also if you are young alot of insurance companys question hysterectomy's. Years ago Dr's did alot of them. I had 3 other minor surgery's before I had "the B IG" one on 3/28. I am a nurse. I have a problem with insurance company's. They hire"non" medical personall to made desisions about someones health. Try not to worry. I truely feel for you and your frustration.Waiting is the worst part.It will get better!!!!!!!!!PRAY!!!!!!Well good luck and keep us posted. Angela
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Unread 04-06-2002, 06:06 AM
Insurance approval questions

I know somewhere on the net there is a site about insurance companies and continual coverage for pre existing am almost positive it is a federal issue, I think it was changed by President Clinton...Try looking under "Insurance Commission"...I had a problem last year, I changed jobs and I was told if I kept my cobra and was offered insurance through my new job, they would have to cover any pre existing conditions...and because YOU didn't change jobs, I don't think they can deny you....that's just my opinion, I am not sure on insurance policiies...Good luck and let us know when you talk to them on Monday!
Unread 04-06-2002, 06:19 AM
Insurance approval questions

Jeannie - When I had my appt. in January with the gyn, his office said they needed at least 2 weeks for the ins. company to grant approval. They asked me to wait at least 4 weeks "just in case" and mentioned that I would have time to call & harrass them if they didn't approve the surgery. Luckily they approved it the 1st time around. (And I was concerned because I had an ins. company change on January 1 like you.)

If you don't get approval, definately continue to question them. Don't give up without a fight!! Non-medical people shouldn't be making these life-altering decisions.

The hard part is waiting ... sorry it involves insurance for you too. Keep us informed.

Unread 04-06-2002, 08:24 AM
Hi Jeannie

I think this is a mix-up that should be resolved for you soon.
I was forced to change insurance by my (previous) employer the same week I was diagnosed with cancer. (I have Cobra now.) I too was scared about coverage and pre-existing condition clauses. My outgoing doctor told me that I was protected because the change in insurance coverage was not under my control. She also said if they tried to decline my coverage for surgery etc., I could sue them for millions!
Let us know what you find out on Monday.

P.S. I have had no trouble getting those claims paid!
Unread 04-06-2002, 10:55 AM
Insurance approval questions

Everyone is right. There is a federal law about pre-existing coverage. If your employer changed insurance plans, they still have to cover pre-existing conditions. Heck, even if you changed jobs, your new employers insurance would still have to cover the pre-existing condition.

If what they are questioning is preexisting, they made a mistake. And they do make them. Hey just last week I got a check meant for my DR. We have the same last name (I always get to answer that stupid question. "No, I am NOT related to my gynocologist." I should start saying "yeah, I am his older sister, and see what response I get!), and they mistyped the first initial on the check and it was sent to me.

I would relax, sounds like a mistake to me!

Unread 04-06-2002, 12:12 PM
Insurance approval questions

It is so hard to cope with regular, everyday stuff when you don't feel good. Throw in impending surgery, insurance company problems, planning for a! Go ahead and plan on the surgery. Make all your lesson plans, etc. Be prepared. WHen you go home tonight, take a bubble bath. Pamper yourself a little. You deserve it!

The insurance company is non immune to mistakes. Hopefully it will be resoved Monday!

Hang in there!!!

Unread 04-07-2002, 05:58 PM
Thanks a bunch!

Your replies really have helped me a ton! After reading them, I kind of got my "second wind", and got myself down to school and got a lot accomplished on Saturday. There's so much more to do and I thought I'd be able to hit it and get it today, but I've been pretty worthless today.

I did another search on Hysters re: insurance and along with some of your suggestions and what I found on search, I printed off a few to have when I begin my calling tomorrow. You all have given me tremendous information about insurance--just as you all do about hysters. You have no idea how much that helps me. I feel I'm as prepared as I could be.

I'd like to ask one more thing...please remember me in your prayers. I've taken years to make this decision and haven't done so lightly. Right now, I want to be calm and be able to sleep tonight so that I can be effective. At first, I thought, well maybe I'm really not supposed to have this surgery. But I don't think that's right.

Will let you know when I know something
Unread 04-08-2002, 03:55 AM
Insurance approval questions

Jeannie -- My prayers are with you today as you make that call. Except for those who were rushed by emergency into surgery, I bet we all were there questioning our decision, and I still have twinges as to whether I did the right thing. Its just like the Little Engine that Could -- instead of "I think I can" I keep telling myself "I needed it, I needed it." There are still times when someone says something they think quite innocent that brings those questions up in my head. And I keep telling myself "I needed it."

Of course, having the big, bad, impersonal insurance company telling you "no" is playing on your fears & emotions too. Just keep remembering all your HysterSisters out there who bravely faced what you are now facing.

Before I found HysterSisters, I questioned about 5 women who had hysterectomies, and not a single one of them would rather have her "parts" back, and all said I would not regret it. Now that I'm nearing the 6-week mark, I would have to agree with them.

Prayers & s today.

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