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Unread 05-01-2002, 04:55 AM

This is what I fear is going to happen to me after my dr appt next week. My dh wants to go with me because he doesn't think I'll advocate enough for myself. I am a real push over, but I think I'm going in with loaded guns (or at least information) to PUSH a little.

I hope you get your approval. I just know your dr will look out for you.
Keep the faith!
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Unread 05-01-2002, 05:05 AM
Insurance denied TAH

That happened to me last year, except that I had already tried the BCP for over a year. The insurance company said we needed to try an Edometrial Oblation first. This is where they burn out the uterous lining, and you no longer (supposedly) have a period for at least 3-5 years. You also need to have 2 injections 30 days apart before having the surgery, at the tune of $975 a piece. I had that Surgery in August 2001. By November I was having my periods again, albate not as heavy, but still needing to take the Darvocet for pain. Dec. I skipped my period, by Jan, Feb, & March I needed the Vicodin. This month I was already taking the Vicodin (2 at a crack) when I needed to go to the ER go such back pains that I could not even stand or sit. I was curled up in the fetal position for almost 24 hrs. They finally gave me some Tordol through an IV, and it made it tolerable. Saw my GYN on Wed. and am scheduled for a TAH on June 3, 2002. He wanted to do it sooner, but the hospital was booked.

Good luck on the appeal!!!
Unread 05-01-2002, 06:40 AM

Hi Jo,

I'm praying for you girlie! I hope this all gets sorted companies are something I cannot relate to as we are military. I do remember dealing with them though as before the system we use now, there was an awful system. I'm so glad it was replaced!

Please keep us informed!!

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Unread 05-01-2002, 06:57 AM

I think what I find so appalling is that we have to fight at all. Isn't the physical pain and discomfort enough to go through. It amazes me how many people have been denied to make suffer more then to be approved which was the right thing in the first place. Thanks for the prayers.
Unread 05-01-2002, 09:40 AM
Insurance denied

Let me tell you,,,,I didn't even KNOW insurance companies could veto what a DR finds as a necessary treatment unitl my DR said,,,You need a hyst, but not sure if insurance will OK it. You've GOT to be kidding!!!! I will never complain about my ins company again as they have never questioned anything for me or my family. I am so sorry you are going through this. Write a letter WITH your DR so that you know nothing is left out! Kep trying. Speak to supervisors at the ins company if necessary. You are in my thoughts. Gosh...this isn't even happening to me and it makes me so angry!
Unread 05-01-2002, 09:56 AM

You just got to love those insurance companies! My doctor wasn't sure they were even going to let me stay over night after my hysterectomy ehich is scheduled for next Tuesday. But here's how much the people approving things know when I called for the pre admission approval that is reqwuired I told the woman that I was having a Laparscopic Hysterectomy she said you mean a vaginally assisted laparscopic hysterectomy, I told her no, just a laparscopic hysterectomy, she told me I didn't undersatnd they were the same thing, I tried to correct her but she very polietly told me that I must have misunderstood my doctor that that was how they were done! See, Blue Cross Blue Shield isn't even aware os the latest procedures so how can they make accurate decisions????? Aghhhh!!! And we trust these people with our health care kinda makes you crazy doesn't it!!! Lucky for me though that they were confused because they approved me to stay over night, my doctor says that if they realized it was just a laparoscopy thaaey probably would have made me go home.
Unread 05-01-2002, 10:10 AM
Insurance Denial

This happened to me in 2/99 and had a positive outcome, so I will share.

I have bad adeno, and was also undergoing IVF. In order to preserve my fertility, my doc wanted to do a pre-sacral neurectomy, which cuts the nerves between the uterus and the spine so you do not feel the pain. It eventually grows back, but bought me a couple of pain free years to continure my treatments.

My insurance denied it, as their checklists determined the best course of treatment for me was 6-12 months of BCP's. HIGHLY counterproductive to the in vitro! Boy, did I ever unleash a hormonally induced wrath of @#*% on Blue Cross/Blue Shield!

At the time, I worked for a company that got insurance through our local retail merchant organization. They were a big client, so the HR guy there leaned on them as did my doctor, and it was approved. So, don't give up until you rattle everyone's cage! Feel free to call me, if you need help!
Unread 05-01-2002, 10:24 AM
Oh no Jo!

I am so sorry to read this.. I remember talking to you about this a couple of weeks ago. Hopefully your Dr will go to bat for you and explain that you cannot do this for another year. I am praying for you. Go ahead and throw your lemons as hard as you can.. when your done.. have yourself a good cry.. then when your done with that.. pick yourself up (we will all help) and fight the good fight. Chin up!

Unread 05-01-2002, 11:46 AM
the latest

Today the doctors office called me to tell me that they had cancelled my surgery for the 7th as the insurance company had denied my request. And that my doctor wasn't going to call the review doctor to plead my case. How's that make you feel? He said at this point we just have to let the process takes it course.

Do you feel like your asking to change your hair color? Anyway, I called the insurance company who told me that my case had gone to review and they had until Friday to decide but I could call tomorrow.

So I call the doctors office back to say don't take me off just yet. Too late. THey had already taken me off the schedule. Can I go back on if I get approval? Probably. OY!

And last night the bladder leaking problem went to another level. I stood up from lounging on the sofa and urine just started coming out. I could do nothing to stop it. I made it to a tile floor and my DH tossed me a towel which I also soaked. So now I guess I have to buy depends? My doctor did share this tidbit with the ins company. Maybe it helps. I've really given up all hope of the 7th. I know if they approve, I can go for the 21st but thay means another horrendous period. (And you know its nice to say that to you guys because you know what horrendous really is)

I'm trying hard to find a smile and keep it but I'm going to need to make a grocery run to replace the lemons.
Unread 05-01-2002, 12:16 PM


Get some more lemons and throw them HARD at the people at your insurance company. Geesh ~ if only they could be in your shoes maybe they would be more sympathetic.

Sorry to hear you are still having a rough go at it, but try and hang in there.

I hope your insurance company approves you soon for this surgery so you can get rid of your problems.

Let us know what happens, please?


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