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.
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.
I know this is a long time after you posted this, but I’m currently dealing with the exact same situation. I’ve had endometriosis as well as heavy bleeding for over a decade. Fibroids, cysts, all of it. I made a very well thought out decision to have a hysterectomy and my insurance denied it. Ithe peer-to-peer request was denied as well. I just sent out a personal appeal detailing the terrible impact it’s having on my well being. I found your post after researching what avenues I should take next, and you have greatly encouraged me. Still waiting to hear back on my appeal, and hopefully it will be good news.
ReplyDeleteI shared my story because I say while going through this that it is common. I really hope you are able to get it approved. It is just so frustrating that we have to jump through hoops to get a surgery we need. I was severely anemic and spending so much on infusions every other month or so. I have not needed an infusion since my surgery! Please update when you get news!
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DeleteCan you share an example of your letter? I’m at currently going through this exact same thing. I have had 2 iron transfusions and I am so upset that my insurance will not cover my surgery!
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ReplyDelete