Grrr I am so mad at my insurance company

Ok who the heck decided to give health insurance companies so much power? They denied my surgery for my Histarectomy. Not enough evidence!:censor::censor::censor:?!! I am sooooooooo mad, i will still see the dr on monday for what should have been my pre-op to see what we can do but i will be darned if i will do other procedures before they approve this. I am soooooooooooooooooooooooo mad. Never mind that i have severe endomytrosis, my uterus doesnt always contract right and the pelvic muscles/tendons are loose. Nope nope insurance says no. Since when do they have the right to override a dang PROFESSIONAL.

Its for your health...not cosmetic? And they won't pay?

I don't know how much truth there is to the rumour, but I've heard that the medical insurance companies will automatically just say no the first time you submit. If you contest it and push, they'll agree.

Thats just ridiculous!

Its not like you are getting a boob job or a face lift??

I would definately keep pushing the point until they say yes!

Well i see my dr monday and will see if there is any other tests(without doing surgeries) that would add to the file so they cant say no. The lady who deals with the insurance said that maybe laproscopic surgery just to take pics and do exploratory would help, so i will ask the dr about that. My dr warned me they might say no, she has had them REQUIRE women to go through other procedures first(like scraping the lining of the uterus) before they will subseed and say ok. The lady did say we could submit again and see what happens, she said there are cases were it also depends on who is doing the paperwork on the insurances end. I plan to call the insurance today and chew someone a new one. I told my husband if we cant get them to say yes i WILL NOT do anything more than exploratory, i will not allow an insurance company to force me to do needless surgeries just to proove to them. Meanwhile maybe there is a way to stop my periods with medicine so that we dont have to worry about weither i contract right so i dont get an infection. I dont know. I am just sooooooooo mad about this. Yawl are right, its not like i am having my tummy tucked, its a freaking Hystarectomy. I mean i would think it would be enough "evidence" for them that my dr is suggesting something this serious and i am only 26, sheesh, i mean i had my tubes tied 3 years ago so its not like i am looking for an easy birthcontrol method.

I can't believe they said no. It's not thier right to tell you it's not a needed surgery.

Sorry to hear your insurance company is being stupid. Hopefully they will approve it if you submit the paperwork again!

Can't you call and explain the situation to the insurance provider? Maybe if they hear your side, they might change their minds.

Originally Posted by Yosemite

I don't know how much truth there is to the rumour, but I've heard that the medical insurance companies will automatically just say no the first time you submit. If you contest it and push, they'll agree.

Click to expand...

That, and the fact is that approval has EVERYTHING to do with the way that your doctor words the information. Ifthere is the slightest hint that the surgery is not medically necessary, they'll deny it.

My doctor stated that my hysto was necessary because it could become life-threatening, even though it truly wasn't. It was necessary for quality of life, but not to save my life.

Please talk to your doc about the wording on the pre-req.

What kind of plan do you have? PPO? HMO? Medicaid? Self-insured TPA?

A lot of answers can be found on the kind of plan you have on yourself.
Also a lot depends on your MD's staff. Insurance will put you thru a bunch of hoops and you only have to play the game correctly if you wish to win.

It also is very common for a payer to require lesser procedures first, since a hysterectomy is a last resort in their opinion. (Also, are you requesting a full or partial? Generally a partial only will be approved up front with a full completed years later).

I work on denied care for a living, and I win most of my cases.

I am on medicaid because i am on SSI for disability (multiple sclerosis) my dr wants to do a removal of all but teh ovaries, at 26 and my mother not having menapause till 40'ish she said she thinks i should have a good bit left on my ovaries and despite the fact that i suffer from cysts every month it would be wiser to leave them instead of throwing me into a forced menapause. i am getting ready to call medicaid now to find out what the heck happened.

Good luck. I hope you get it sorted out. That sounds like a very painful condition and to have your insurance company tell you what to do just add insult to injury!

Well they called me back and said they would get in touch with the reveiew board and find out what my dr can do to insure i get approved, meanwhile when i see my dr monday she wants me to find out exactly what all was sent to the insurance company concerning my case.

Malikitty - I am sorry for your troubles.
I'm very surprised Medicaid would deny such a case - if they have the right info. I'm glad you are following up with them. The medicaid in each state is very rigid in their guidelines, but also very good at covering most things you can think of. A provider must be v. careful in following their rules.

You can call them and yell if you want...but from experience I can tell ya - it never does any good with the state !

Getting in touch and them reviewing your denial was very good action IMO.
Also, the partial idea is a good one too IMO.