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I'm so bummed

post #1 of 21
Thread Starter 
I was supposed to get plastic surgery on Monday to fix the scar from my heart surgery. DH and I want to start a family, and we're ready, but have been waiting to get this out of the way.

They just rang to say they still haven't gotten approval from the health insurance company, the surgeons office keeps getting the run around by them.

So they're going to have to cancel the surgery until they get approval from my health insurance company, which they reckon may take another couple of weeks, then it's going to be at least another month until they can reschedule me.

I'm sick of waiting until I'm allowed to get pregnant. At this point, I think I'm just going to cancel the surgery and hope my scar doesn't keep growing too much.
post #2 of 21
Aw that stinks! Do insurance companies normally cover plastic surgery? I've got two moles on my face I've been wanting removed but since my doctor keeps saying they look fine, she hasn't sent me to a surgeon yet. So I'm thinking if I want it done, it'll have to be out of pocket.

I hope they figure out something for you soon!
post #3 of 21
Sarah sweetie, I know it must seem like an eternity for you Try to hang in there honey

When I was having issues with my insurance company, I found that if I called them directly and asked to speak to the specific dpt. I needed, I got a lot farther and got results a lot quicker than waiting for my doctors office to fight it out with them. Can you give your insurance company a call and talk to one of their supervisors/etc and expaline the situation? That way you get things fast tracked a lot quicker.
post #4 of 21
Sarah,

its just a couple of weeks, give them a call. See if that can help hurry things along.
/HUG , but first take care you, then worry about the other
post #5 of 21
Quote:
Originally Posted by MoochNNoodles View Post
Aw that stinks! Do insurance companies normally cover plastic surgery? I've got two moles on my face I've been wanting removed but since my doctor keeps saying they look fine, she hasn't sent me to a surgeon yet. So I'm thinking if I want it done, it'll have to be out of pocket.

I hope they figure out something for you soon!
Her's isn't just for the sake of vanity. She's talking about her incision scar from her heart surgery, which is more than cosmetic. It's the type of scar that can continue to grow and it can affect underlying tissues, not to mention scar tissue is unstable and doesn't have the ability to stretch which also makes this a medical requirement.
post #6 of 21
Can they not rebook you for a couple weeks from now so that way if they do get approval by then you can just scoot right in?

I hope you get this resolved soon. Being caught in bureaucracy is awful!
post #7 of 21
You might want to ask your doctor to write a letter of medical necessity to the insurance company making them aware of the complications that could occur if the procedure is denied. I wish you the best of luck.
post #8 of 21
Quote:
Originally Posted by nurseangel View Post
You might want to ask your doctor to write a letter of medical necessity to the insurance company making them aware of the complications that could occur if the procedure is denied. I wish you the best of luck.
That's a wonderful idea! I would do that in addition to directly calling the insurance company!
post #9 of 21
sounds rough... relax if you can.

Wish you luck
post #10 of 21
Quote:
Originally Posted by theimp98 View Post
Sarah,

its just a couple of weeks, give them a call. See if that can help hurry things along.
/HUG , but first take care you, then worry about the other
Yup, I agree.
post #11 of 21
Thread Starter 
I'm fine with it now. I was really upset initially, but I figure we'll book it in, and try to get it sooner, and if I manage to get pregnant by then, I'll cancel the curgery and hope the scar doesn't get too much worse over the next year or so.

What's really annoying is that the bottom part of the scar is almost invisible, and the rest is scary looking!
post #12 of 21
Do they know why you scar is like that?
My Dads was bad at first but looks alot better now.
It has ben two years though.
I have seen her scar.
i hope it will be taken care of soon.
post #13 of 21
Thread Starter 
I got a staph infection in the incision after surgery, which made it worse, and I don't heal well at the best of times. Part of it is keloid, which means it will keep growing beyond the boundaries of the scar.
post #14 of 21
Thats terrible.
I hope it can be fixed soon so you do not have to worry about it.
post #15 of 21
Oh, I am so sorry

My insurance company seems to always take forever too. But, I can usually have stuff done, then ignore the bills and they pick it up. Some of these people seem to think we are dumb enough to pay twice.

Keloids suck. I used to have a yucky one in my ear from a bad peircing. It was annoying is all.

I gotta agree, as much as you want to have a baby, you should take care of this first if at all possible, Just in case. I could tell you a scary story, but suffice it to say that it is always better to get it over with before getting pregnant. I hope everything falls into place very very soon!!
post #16 of 21
Quote:
Originally Posted by sarahp View Post
I got a staph infection in the incision after surgery, which made it worse, and I don't heal well at the best of times. Part of it is keloid, which means it will keep growing beyond the boundaries of the scar.
I have seen your scar, too, and we talked about my DH having the same incision without the same problems with the scar. But you do have that keloid which does mean that the scar is growing, upwards towards your neck.

Sarah, hope that the health company figures out that this can be healthy for you.

You know that my thought's are always with you.
post #17 of 21
As someone who works regularly with insurance companies, I can tell you that I would be calling them, asking for supervisors, asking for medical review, asking what provider records exactly they need (they almost always buy themselves time by saying that they "need clinical records") and who's attention those records should go to. Don't take no for an answer. Ask for the medical policy if you have to.

It's not my personality to do this normally, but I have found that I have to (it's not specifically my job, but I often end up as a patient advocate) --the squeaky wheel gets the grease. I would start calling on Monday and not stop until they give you a concrete timeframe. That scar needs to be taken care of and you should not be putting your life on hold because they are dragging their feet. It makes me to hear these kinds of stories.

They know you had heart surgery and a staph infection --this should be a no-brainer.
this gets resolved in your favor.

Another thing you might look into is whether or not your husband's company (it's his employer insurance, right?) has someone that advocates for employees on the company coverage. (I say that because at my company that's me ) They can't tell the insurance to pay it, but they might know who to call to speed things up
post #18 of 21
Thread Starter 
Quote:
Originally Posted by Meowers View Post
I gotta agree, as much as you want to have a baby, you should take care of this first if at all possible, Just in case. I could tell you a scary story, but suffice it to say that it is always better to get it over with before getting pregnant. I hope everything falls into place very very soon!!
I'm happy to hear scary stories - I don't think anything could scare me

Quote:
Originally Posted by butzie View Post
I have seen your scar, too, and we talked about my DH having the same incision without the same problems with the scar. But you do have that keloid which does mean that the scar is growing, upwards towards your neck.

Sarah, hope that the health company figures out that this can be healthy for you.

You know that my thought's are always with you.
Thanks Rosemary

Quote:
Originally Posted by JellyBella View Post
As someone who works regularly with insurance companies, I can tell you that I would be calling them, asking for supervisors, asking for medical review, asking what provider records exactly they need (they almost always buy themselves time by saying that they "need clinical records") and who's attention those records should go to. Don't take no for an answer. Ask for the medical policy if you have to.

It's not my personality to do this normally, but I have found that I have to (it's not specifically my job, but I often end up as a patient advocate) --the squeaky wheel gets the grease. I would start calling on Monday and not stop until they give you a concrete timeframe. That scar needs to be taken care of and you should not be putting your life on hold because they are dragging their feet. It makes me to hear these kinds of stories.

They know you had heart surgery and a staph infection --this should be a no-brainer.
this gets resolved in your favor.

Another thing you might look into is whether or not your husband's company (it's his employer insurance, right?) has someone that advocates for employees on the company coverage. (I say that because at my company that's me ) They can't tell the insurance to pay it, but they might know who to call to speed things up
Thanks so much for the advice, I'll give them a call!
post #19 of 21
I think you said you were on Cigna before? The same insurance company that denied to pay for a teenager's liver transplant (some will remember that story, it was later allowed but to late to save her). Not good prospects...

I used to have Cigna. A few larger bills always had to be resubmitted 2-3 times by clinics and labs, they'd always file them wrong or lose them the first time.

And if you don't have Cigna... who am I remembering from here that does?
post #20 of 21
Thread Starter 
Yes I do have Cigna. They've actually been really good. We're lucky to have good insurance, so we've been ok. It will be interesting to see what they say.
post #21 of 21
Ok - good. Otherwise I would have used the "it's late and I'm kind of sleepy" excuse if I remembered wrong.

I had PPO with them, and do think they're better then the Aetna DH and I have now. But if they can deny a dying teen a liver, don't be surprised if they deny you a cosmetic surgery (no matter how needed it is).
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