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Insurance approval? Insurance approval?

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  #1  
Unread 03-18-2003, 04:13 PM
Insurance approval?

Maybe I'm living in a shell here, but I can't believe an insurance company would deny a hysterectomy!! It's not like this is cosmetic surgery or something. Who in their right mind would choose to have a hysterectomy just cuz' they have some free time?!! What is the world coming to when women must continue to suffer, because an insurance company doesn't want to pay for an operation their doctor says they need.

I'm sorry some of you have had to go through appeals and all that mess. I haven't given one thought that my insurance company would actually deny my claim - but maybe I should be so sure about that.

Okay, no real point to this post I suppose - just a little vent and consoling for those of you going through this.
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  #2  
Unread 03-18-2003, 06:22 PM
Insurance approval?

Hi Traci---

It is frustrating that some insurance companies are so restrictive about approving a hysterectomy. Many of them require certain pre-operative measures to be tried first before approving hysterectomy. Many women have to deal with this now, in the age of managed care insurance providers.

I'm sure your concerns are greatly appreciated by women who are having to deal with insurance difficulties. I think the best advocate for women who are faced with this is a good doctor who will document their difficulties and really go to bat for them with the insurance company. My doc went to bat for me on my surgery and it was all paid for. I was one of the lucky ones as well!
  #3  
Unread 03-18-2003, 06:27 PM
Insurance approval?

cI know it's hard to believe that insurance co. could do this to me. but in fact they did. My gyn was so infuriated , but really could have done more to help me fight it-- I think. Now she doesn't want to do the lap, because she says she is not going to let an insurance co. tell her what to do. Unfortunately, that leaves me in an bind. That's why I need to find another doctor. I am also considering acupuncture for my pain. Has anyone had any luck with this option?
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  #4  
Unread 03-18-2003, 09:49 PM
Insurance approval?

I got pre-approved for my hysterectomy and had it done, two weeks after they sent me a bill for 12,000 from the hospital and (anistiologist?) They denied me after approving me so I know exactly what you are going through, except I had mine and now stuck with a bill I can't afford. To top it all the wouldn't renew my policy and I cant get insurance anywhere...... Insurance is a crock!!!
  #5  
Unread 03-18-2003, 10:51 PM
Sure...

They said, yes... PLEASE, please have the surgery
Just kidding.
Although I'm sure they were happy to approve. Since I have a bleeding disorder, my insurance shells out anywhere from $8,000-$30,000 each month (depending on how bad my period is) for a blood product that I have to infuse into myself. (I'll be happy that will be over!).
I think they approved my "scar repair" (mini tummytuck) as an incentive to go ahead with the hyst.
Thinking the insurance folks will be having quite a party!

22 days and counting.....
  #6  
Unread 03-19-2003, 05:02 AM
Insurance approval?

Susi: 'scar repair' Oooooo - good one!! Mmmmmm, I could sure use some 'scar repair' as well.

june: Oh my goodness girl!! I can't believe they reversed their decision and sent you that bill!!!

dbromer: I hope you're able to find another doctor. I wish insurance companies who leave the doctoring to the doctors!
  #7  
Unread 03-19-2003, 05:51 AM
Insurance approval?

  Quote:
Maybe I'm living in a shell here, but I can't believe an insurance company would deny a hysterectomy!! It's not like this is cosmetic surgery or something. What is the world coming to when women must continue to suffer, because an insurance company doesn't want to pay for an operation their doctor says they need.
Like Shelley has already said, in this day of managed care the insurance companies do have that power. If you review your program documents you will see that.

A hysterectomy is considered elective surgery, except where cancer is suspected. There are less invasive alternatives, such as drugs like BCP's which may offer some relief, D&C, Thermal ablation, myomectomy, etc, which may or may not be 100% effective. The insurance companies are vilified by both the anti and pro hyst camps - either they approve surgery so they can save money by not paying for other treatments first, or they deny surgery and want to save money by trying other treatments, depends on your view.

There is concern that in the past way too many unnecessary hysts were being performed without giving alternatives any thought at all. The medical community came under fire for that, and it can be said that the insurance companies are responding to that by making sure that a hyst is the last alternative.
  Quote:
Who in their right mind would choose to have a hysterectomy just cuz' they have some free time?!!
Oh yes, every so often someone will post that they are done having children and even though they have no medical reason, they are planning to ask their DR's for a hyst because birth control is so inconvenient. Honest. It does happen. I can't imagine any DR could possibly be that unethical, but if it's gonna be paid for why not??

(((june29620)))
  Quote:
I got pre-approved for my hysterectomy and had it done, two weeks after they sent me a bill for 12,000 from the hospital and (anistiologist?) They denied me after approving
Do you have the approval in writing? Generally the patient, DR, and hospital will each get a copy of the pre-authorization. If they approved it you have a legitimate claim. I would suggest contacting the insurance licensing division or complaint office in your state. Keep detailed notes of every conversation with anyone about your surgery - names, dates, etc. I hope you can get this resolved.
  #8  
Unread 03-19-2003, 06:28 AM
Yes Indeed...

You would be surprised (or maybe not!) how many women said "I'd LOVE to get rid of ALL of this mess." or "I'm all done with having kids, I don't need these parts anymore, why bother?"--It's called CONVENIENCE to these women, to put up with surgery and all that- the convenience, the end, justifies the means.

Radical? Yes! Uncommon? NO........

The insurance companies more and more are in a bind between patient need, and financial concern. Cutting costs, the bottom line, influences every decision. Your doctor is your advocate. And if he/she isn't, you have to be.

It's business. YOUR business versus BIG business.

You are more important when your health is at stake.
  #9  
Unread 03-19-2003, 06:38 AM
Insurance approval?

Oh my stars!!! Well, I guess I live a sheltered life - I just can't imagine choosing a hyst just as a method of birth control. <shaking my head> It's sad, because now those who really need it, have to fight to get it.
  #10  
Unread 03-19-2003, 11:29 AM
Insurance approval?

Ya know, there are people like that. After I had mine done I have a friend who says to me "You lucky ****!" I'm like HUH???? Lucky? What's so darn lucky about having a TAH? Well I said hey go through 10yrs of constant pain to the point where you would rather die then go on and deal with it the next day and then if you find the right Dr. you might get it. But remember the dreaded pain and all the pain killers you'll have to take and how they mess your system up and on top of that not have much of a life because your pain is too much to deal with. She goes... "no thanks" Ya, that's what I thought. Hey, for all I've been through I deserve not to get my period anymore... Finally for once in 10yrs I am pain free.... I earned it dangit.

I wish I was "normal" and didn't have the problems I had... I wouldn't have waisted 10yrs of my life.... I'm now 31 and can feel good and live... too bad my kids (13, 12 and 12) had to live through it with me...

angie
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