insurance denying surgery, has this happened to anyone?

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sparkn
Regular Member


Date Joined Apr 2003
Total Posts : 273
   Posted 6/25/2008 5:42 PM (GMT -7)   
Hi, I have had Crohn's since '91, have had an ileostomy, lots of other surgeries including one for a perineal abscess two years ago. Well, I have another perineal abscess and my surgeon wants to remove it (which I guess I have to unless I want to get really sick, and if I want to sit or walk without pain again), and also have a second surgery to put healthy tissue in the area that I keep getting abscesses to prevent any future ones. Well, the two surgeries are scheduled for July 10th and 14th, I have met with both surgeons, am all ready for it (except for being mentally ready) and my surgeon's office calls today to say Blue Cross sent them a letter denying the surgery.....of course by the time I got the message it was too late to call the Dr and Blue Cross. Has this happened to anyone? What is the appeal process like? I teach and need to get this done before school starts, they said it was a 6 week recovery, with the first three weeks pretty much home bound (no sitting allowed.....). I am stressed enough without having to deal with the insurance company --and they have never denied anything before, advice???
Happiness is a journey not a destination - Souza


ski bum
Regular Member


Date Joined Jan 2007
Total Posts : 451
   Posted 6/25/2008 6:17 PM (GMT -7)   
Hi Sparkn. I hope the denial was a clerical error because it makes no sense to deny surgery for an abscess. There should be a contact person and number on the denial letter. I'd start there. Good luck!!
50 y/o F. CD dx'd Aug 05. Initially on Pentasa, then Imuran 125 mg. Started Humira (very reluctantly) on 10/24/07. Ileocolectomy 4/08.


AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 6/25/2008 6:43 PM (GMT -7)   
(((((( Sparkn ))))))))

SO sorry you are having to deal with insurance issues when you are facing such a delicate surgery and recovery.

I think Ski Bum is right and this is either a clerical error or there is a process by which you or your doctor can help them realize this is not an elective surgery.

They may be balking at the two surgeries so near each other. DUH! how else would it make sense to do this.

I've recently had friends who dealt with denials until the last minute. . . and then the way was cleared for them. But I hope you get quick resolution. You sure don't need the stress of waiting for clearance.

Keep us posted on your progress in dealing with them.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

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Faizi
Regular Member


Date Joined Oct 2006
Total Posts : 451
   Posted 6/25/2008 10:14 PM (GMT -7)   
It must be an error of some kind. They cannot deny that. God knows, insurance companies cause lots of problems -- like denying the medications that could help avoid surgery but they do not generally deny surgery. Of course, you will have to appeal. I wish you the best of luck and let us know what happens. It is an outrage.

sparkn
Regular Member


Date Joined Apr 2003
Total Posts : 273
   Posted 6/26/2008 5:47 AM (GMT -7)   
Thanks for the replies! It is making me feel a little better, I will call the insurance company when they open, and my doctor's office has been emailing me saying they aren't worried....I'll keep you all posted!
Crohn's Disease since 1991, 2 rounds of ng tube feeding, Ileostomy since 1993, Proctectomy in 1997, several resectionings & stoma revisions, many blockages and a few abscesses and surgery to remove them. Medications used at one point...prednisone, 6MP, Flagyl, Asacol, Pentasa, Imuran, Cipro, Rowasa, Cortifoam, Methotrexate


Happiness is a journey not a destination - Souza


karendee
Veteran Member


Date Joined Mar 2007
Total Posts : 1642
   Posted 6/26/2008 7:22 AM (GMT -7)   

Good Luck! Make sure you ask for an apeals department as well. I would call several departments of the Ins Company.

Also. your HR might be able to help. I am an HR admin and I have used my connections for an employee before regarding some meds that were being denied and hospital visits etc. Some HR reps can help. Worth asking them if you have one...
Karen


 ...

Karen (Karendee)

Diagnosed w/ Crohn’s Disease  March 2007 On 150mg Azathioprine (generic Imuran), Pentasa, & Entocort Switching to Humira June 2008 will wean off Pentasa and Entocort

Diagnosed w/  Fibromyalgia May 2007 also on Soma - Also on Prilosec for reflux.

 

 


LBJ
Veteran Member


Date Joined May 2005
Total Posts : 511
   Posted 6/26/2008 8:46 AM (GMT -7)   
WOW I really hope you get it all figured out!!! We have Blue Cross and I've been fighting with them for months over a dentist bill they are refusing to cover. I have two dentist saying I needed a crown put on a tooth but Blue Cross is saying the tooth wasn't bad enough for a crown so they are refussing to pay it. YAHH!! I'm not liking Blue Cross
lately. So I really really hope you get your issued resolved!!!
Living with Crohn's Disease since Jan./2000 but had a few years prior
I'm a true Crohnie with IBS too
 
Meds I have tried:  Just about everything 
Meds currently on:  Prednisone 30mg tapering
                           Methotrexate injection 12wks
                           Folic Acid
                           Wellbutrin
No Surgeries
 


sparkn
Regular Member


Date Joined Apr 2003
Total Posts : 273
   Posted 6/27/2008 4:16 PM (GMT -7)   
So, I think it is all ok. My surgery was originally on June 30th but was rescheduled for July 10th...my surgeon's office faxed bcbs to cancel the first date and they faxed back with a denial letter for the original surgery date - not an actual denial for services. My surgeon's secretary is new and should have called the insurance company herself to figure out what was going on before telling me and getting me all stressed out for nothing. So, I think (hope!) it is all going through without a problem. Thanks for all the advice and support! And LBJ, I can't believe blue cross dental is doing that to you, do they want your tooth to rot completely before fixing it? That is ridiculous, fight on!
Crohn's Disease since 1991, 2 rounds of ng tube feeding, Ileostomy since 1993, Proctectomy in 1997, several resectionings & stoma revisions, many blockages and a few abscesses and surgery to remove them. Medications used at one point...prednisone, 6MP, Flagyl, Asacol, Pentasa, Imuran, Cipro, Rowasa, Cortifoam, Methotrexate


Happiness is a journey not a destination - Souza


CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 6/27/2008 7:12 PM (GMT -7)   
Thanks for sharing the good news!! Good luck!
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.

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