Skip to main content

When Insurance Turns Down Your Hysterectomy

So, in my last post I shared that insurance turned down my surgery THE DAY BEFORE the big day!

My hysterectomy was originally scheduled to happen just before the holidays.  I had been so nervous this would happen.  I admit it, I was a pest.  I called the physician's office several times in the weeks leading up to the surgery just to see if insurance had approved the procedure yet.  Each time they said no but that wasn't unusual and there was no reason the surgery would not be approved.  I called my insurance company several times.  I was told each time that this was pretty standard and not to worry.  I was skeptical because our insurance company hasn't been the easiest to work with but I didn't push it.

The morning before surgery, I called my insurance company.  The gal told me that coverage was denied.  She couldn't tell me why it was denied so I called my physician's office.  They hadn't even noticed that it was declined.  I was told to continue fasting and they would do a peer-to-peer to convince them to cover it.

The doctor had her assistant do the peer-to-peer with the insurance company (something I didn't find out until much later) but still they declined.  I personally don't think she was up for the task.  This was a new doctor, chosen because I wanted a really good surgeon and I had heard positive things about her.  At the initial consultation, she didn't even listen to my entire history before declaring that I didn't need to convince her for the surgery so they never really had a full arsenal to fight the insurance company on this.  Add to that that we had only had this insurance company less than a year, even the insurance company didn't know my full history.  Add to this that one gal at the office later told me this had been the assistant's first peer-to-peer, well, I didn't stand a chance. 

Understandably, I was upset.  I was hungry from fasting and I had been so stressed about this surgery that I just broke down.  I don't think the nurse had any clue what to do with me because I just was crying by this point.  I just wanted this to be over.

I took a few days for my pity party and knowing the doctor wasn't going to be able to sway the insurance company, I wrote a four-page appeal detailing my history with anemia and what my day-to-day life is like with this anemia.  I made sure my insurance company knew that this started more than a decade ago and now I get frequent iron infusions which leave me ill much of the time.  When you factor in the month before my infusions when I am just exhausted and catching everything under the sun as well as the month after my infusions when I feel like I am battling a virus due to my body seemingly trying to fight off the iron, I spend over half the year feeling unwell.  No woman should have to feel like this if there is something to 'fix' it.  Oh yes, I also mentioned how much the cost of these infusions have been (a good guesstimate) over the years and that it had already exceeded the cost of a hysterectomy. 

I received my reply a month later.  Surgery was approved. 

If your insurance cancels your surgery, take the time to write an impassioned letter describing, in detail, why you need the surgery.  Sometimes you need to be the one to make things happen.

Was your surgery declined because of insurance and did you later get it approved.  I'd love to hear from you. 

Comments

Popular posts from this blog

Had a Hysterectomy! Did it FINALLY Cure My Iron Deficiency Anemia?

Last I posted, I mentioned the possibility of a hysterectomy.  Long story short (perhaps I'll blog about that next), my surgery was canceled because the insurance company decided the day before the surgery they would not pay for it!  To say I was a mess that day is a huge understatement.

Fast forward, I sent the insurance company a long letter detailing my day-to-day existence with anemia and the side effects from my too-frequent infusions. They approved the surgery.

I'll blog more on the experience of surgery but I ended up having a Da Vinci Robotic Hysterectomy.  The doctor made four small incisions and operated the controls from outside my body! 

Let me just say, this surgery was far more difficult on me than I thought it would be.  Recovery has been slow but, reading online, I see that is common for many women which makes me feel just a bit better.

About six weeks after my surgery, I had my bloodwork done.  I was a nervous wreck.  I didn't feel anemic but, then again,…

Ferrlecit - My Favorite Iron

Is it possible to have a favorite iron?  Seems strange but, yes, I do have a favorite iron now.

Posted last time about how exhausted I was and I was exhausted.  When my ferritin levels get low, I just get so tired and try to fit in naps when I can.  I'm a pretty busy mom and just don't have time for that level of exhaustion.  Along with the exhaustion comes such guilt.  I feel so guilty for needing naps or just not being able to do it all. 

So, had my levels tested in February.  My hemoglobin was fine.  I think it was in the eleven range which is great for me.  My ferritin however was below 10.

Just a little side note:  If you are tired and suspect anemia, always ask for your ferritin numbers.  Even if your hemoglobin is normal, a really low ferritin score indicates that there is a problem and you will be anemic soon.  Often, exhaustion sets in once your ferritin is low.  You can avoid all the additional problem with anemia if you treat the low ferritin.  Iron pills will usua…

Getting Serious About My Iron Deficiency Anemia - It's Hysterectomy Time!

WARNING: May be too graphic a post for some

I was diagnosed with Iron Deficiency Anemia more than thirteen years ago and have been treated with iron infusions for more than five years.  Although a hysterectomy has been suggested a few times over the years, I never took it seriously.

I am now.

So what has changed?

I am not 100% certain my anemia is caused by my cycle.  We've stopped my periods with the use of birth control pills.  I still needed infusions.  I've lessened the flow radically with Lysteda.  Still needed infusions.  Had to give up the pills because, after an extended time on them, I just felt down and lethargic (yes, even more lethargic than with my anemia...I felt the difference).  I quit the Lysteda because the migraines it caused became worse than the pain associated with my period.

But, my periods have become worse.  I did a crash diet a few years back and it seriously altered my cycles.  They were never great to begin with but they've become absolutely unb…