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  #1  
Unread 05-11-2002, 07:28 PM
Insurance Company

I just received a letter from my insurance company approving the hysterectomy, bladder and rectal repair. But I am confused about the length of stay. The letter only states that I have an admission date of June 14. It doesn't tell me how long the hospital stay will be. My current doctor, who I refer to as the idiot, told me to expect 3 to 5 days. I have good insurance, does that mean the insurance company will pay for this length of stay if I am in for the full five days?

I am also seeing another doctor this week about the possiblity of him doing the surgery. He came highly recommended by a co-worker. Does this mean I will have to go through another precertification? This new doctor practices in a different participating hospital in an affluent neighborhood, and the diagnosis I assume will be the same. This hospital has private rooms and is state of the art in certifications. Does this mean I have to go through another precertification for the same condition? Has anyone gone through this.

I am emotionally attached to this date - I don't think I could handle putting the date off. My sister is taking two weeks off to stay with me and my ex is planning a vacation with my DD to keep her mind off of things. I think he is taking her to Greece. I am currently being treated for another kidney infection and I want to put an end to my relationship with Cipro. My current doctor is a competent surgeon, I just hate him and his staff.

As stupid as it sounds I am also concerned about no longer being "a real woman." Whatever that means. I also am getting pressure at work to have this done earlier because we are going through a down time right now and my services won't be missed as much. As if I don't have enough to think about.
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  #2  
Unread 05-11-2002, 07:47 PM
Follow Intuitions

I am sorry Barbara for what you are going through. All I can say is follow your intuitions. I couldn't take it if I had to deal with a mean Dr. and staff. But that is my opinion.

Think about it, you might have some emotional issues, and the last thing you need is a mean Dr.

I hope another sister can answer your question about precertification. If not, I would call your insurance co. In fact, I would call them anyway. I even called my insurance co. after I received my precertification letter. Just to make sure and that I have no surprises.

I want you to take a deep breath and take care. God Bless You!!!
  #3  
Unread 05-11-2002, 08:34 PM
your work

Your work needs to not pressure you on when to have it done.

Mine started (literally) drowning me in projects as soon as they found out, and it added to my stress big time. When they caled the 9th and told me this 14th, I jumped on it. Work wanted me to go in either Nov or Dec when things slow down.

You need to do what is right for you, on your schedule!
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  #4  
Unread 05-11-2002, 09:09 PM
Insurance Company

Hi Barbara,

I believe you will need to get the pre-cert done again. I think a pre-certification is only good for the hospital and for the doctor doing the procedure. If you change either one it needs to be approved by insurance. I worked for an insurance company for years and that is what we did. I would call your insurance company for their regulations on pre-certs. It could vary by state and by insurance but I know of several companies and the rules were the same. Good luck with your surgery and with your doctors.
  #5  
Unread 05-12-2002, 09:33 AM
Insurance Company

Hi Barbara,
I am in Michigan too! I am not positive, but I think you will have to get certified again with this dr and hospital...my approval paper said I was approved for a 1 day stay at the hospital, but it also stated that they will be in constant touch with my surgeon on my progress, which meant what the dr said would go! My dr actually wanted to keep me 48 hours but I begged to go home after 24....I would definately call your insurance company and find out. I called mine around 5 times the week before my surgery because I had not received any verification of pre approval and I was worried.....where in Michigan are you? I am near Grand Rapids....Best of luck to you, and do not let your job stress you out!
  #6  
Unread 05-12-2002, 10:09 AM
Insurance Company

Hi!!!!!!I agree with the other women. I think you will need a new pre-cert. Not so much for the surgery since the approve that fact you need it. B ut for a diff. hospital and Dr.Prices at hospitals vary that is why certain insurance plans do'nt pay for you to have surgery at ALL hospitals. Also some plans(like mine)it does not matter what hospital you go to.Now that I think about it.....I don;t think I needed pre-cert for my surgery!Also another thing.........Why would you WANT to have major surgery if you did not need it?I have done GREAT post op but still......It has not been a day at the beach!!!!!!!!!!!!!!!!!!!!!!!!!Take care. Angela
  #7  
Unread 05-12-2002, 10:22 AM
Hi MJM93

I am in Wyandotte, which is about 15 miles south of Detroit. Grand Rapids is a nice place. I have visited there many times when my kids were young. I believe we stayed at the Grand Amway Hotel in downtown. Isn't the Gerald Ford museum there? I remember walking across the bridge to go to a museum with T-Rex bones and the zoo there where the tigers would come right up to the glass. The kids loved it.

I can't figure this precertification out. Everyone I read about says that their papers state the number of days. This just states I am approved for inpatient care starting June 14. I do plan on calling.

The reason I am changing doctors is because I have had a total of 15 minutes of his time (after waiting for 2 hours), he doesn't do a pre-op visit and his staff won't schedule one - I have additional questions, which his receptionist said can be handled by his nurse, who apparently keeps her own hours and doesn't return my calls. They make me uncomfortable as to how they would handle complications after the surgery, should they arise. Even if I have questions after the surgery, I am not convinced anyone would take the time to answer them. But I think you are right, I think that will have to recertify. I hope it's not a problem.

This new doctor was recommeded by a co-worker whose mother is a RN and one of the benefits is that he practices out of Grosse Point (Michigan's equivalent of Beverly Hills, CA) and he takes my insurance. She claims he is very nice and will spend the time to answer all my questions and is respectful.
  #8  
Unread 05-12-2002, 10:35 AM
Insurance

I work for a mental health agency and my job is to get authorizations from the managed care companies for client's sessions with therapists and doctors. Any time there is a change, even if the change is between therapists in the same office, there has to be new authorizations.

They could deny payment if you don't get the new pre-certification. I know it's a pain but you don't want to be stuck with the doctor and hospital bill. Better to be safe than sorry.

Good luck
  #9  
Unread 05-12-2002, 10:51 AM
Insurance Company

Hi Angela

I guess I don't understand what I said that would make anyone think I "want" this surgery as opposed to needing it. I have two opinions (my internist and a GYN) that I need to have this done, one of the reasons is that I am at risk for permanent kidney damage due to the fact that bladder and uterine prolapse are causing urinary obstruction which in turn causes kidney infections. I want my life back. I am tired of taking and changing antibiotics and taking pain meds when I get pyelonephritis not to mention the vomiting that goes along with it.

I am just not happy with the gyn who is scheduled to do it for a variety of reasons, some of which I listed. Another reason is that he talks "down" to me, as if I am too stupid to understand words that have more than one syllable. He actually asked me during my exam if I ever peed or pooped my pants. If I hadn't been lying down I probably would have fallen over.
  #10  
Unread 05-12-2002, 10:57 AM
Insurance Company

Barbara, I can't blame you for changing Dr's. If this person who told you about this Dr. is a nurse and she sais this Dr. is good.....Then he is. WE know good doctors! I guess because I have great dr.s it is hard to believe that these Dr.'s who don't answer questions exists.I don't dought what you or any other womens are saying. I just can't believe they continue to practice medicine and stay in business . Well Take care and Good luck!
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