insurance denying j-pouch??

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betsaronie
Regular Member


Date Joined Oct 2007
Total Posts : 318
   Posted 3/1/2011 10:13 AM (GMT -6)   
Has anyone ever heard of insurance denying J-pouch surgery?

I ask because I'm in an insurance nightmare right now. I have HIPPA insurance through Humana, but I've been offered a job that is currently temporary and will most likely become permanent in April at a company with great benefits. I'm scheduled to have J-pouch surgery done on March 21st, but I won't know if my current insurance will allow it until almost a week before the surgery. My problem is that I don't know if I should take the job (which I really don't want) just for the insurance and have to push the surgery back to at least June or if I should just assume my current insurance will cover it and let the company know that I'm not available any more. Any thoughts?

I've posted on j-pouch.org too just was wondering if anyone knew anything here.
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-J-pouch surgery scheduled 3/21/11

Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 3/1/2011 1:14 PM (GMT -6)   
I'm not sure I understand completely but I was in a simliar circumstance. I had my surgery in three steps. The first was on COBRA, because my husband was laid off when his company was bought. That was through Aetna, because that's the insurance we had through his company. I was concerned that when he got a new job our new insurance wouldn't cover the second or third surgery, thinking they might consider it a pre-existing condition. He works for a Fortune 500 company with group insurance so that could have made a difference but our new insurance never questioned it once. I remember asking about it at my follow-up from surgery #1 at the Cleveland Clinic and they made it sound likes it's normally not an issue if you switch insurance.
 
After reading your post again I may have misunderstood your question?? Why would it take so long for your insurance to let you know if they will cover it? Usually, the hospital pre-authorizes all of that stuff as soon as they can to make sure they will be getting paid.

betsaronie
Regular Member


Date Joined Oct 2007
Total Posts : 318
   Posted 3/1/2011 3:29 PM (GMT -6)   
sorry for the unclearness.  It was just a general question of whether or not any one has heard of a j-pouch not being approved for insurance.  I'm not concerned with pre-existing condition clauses as my state allows a 63 day lapse before coverage for pre-existing conditions isn't required and I've had no lapses in coverage.  My surgeon is getting the pre-authorization, but they said that i wouldn't find out anything until a few weeks before the surgery simply because of when my consult was in relation to when i scheduled the surgery. (consult was 1-27 surgery is 3-21) I was told that a week before the surgery was the latest that I'd find out and as of 2 weeks ago my insurance hadn't recieved or approved and pre-aurhorization yet.  My only concern with the new job is that it's not a permanent postition until April so I would have to wait to get the surgery and quite frankly I don't want to wait till june as my rectum still bleeds every day.  I want the darn thing out!! that and I've made plans that would clash with putting my surgery off.  I'm fairly certain that my insurance would cover the J-pouch I just wondered if anyone knew of it not being covered.  thanks for the response though!! :)
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-J-pouch surgery scheduled 3/21/11

Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 3/1/2011 4:12 PM (GMT -6)   
I'm sorry, I got confused. I can't imagine them not approving it though. I hope it all works out for you.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 3/1/2011 5:02 PM (GMT -6)   
I have learned that every state is different, just like every insurance plan!

I'd plan for the surgery, and if something happens with the approval, the doctor will let you know. But, as far as the job part, if you need it you might want to take it. By HIPPA do you mean COBRA that you have to pay for monthly? Moving the surgery by a few month's isn't the worst thing that could happen. Disappointing, yes, but we cannot always control those outside forces!

Have you done a Pro/Con list? That might help to focus on the 'big' picture.
formally known as OHIO76 ~ honoring my daughter's passion!
Crohn’s dx 1989
some terrible years before my temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

betsaronie
Regular Member


Date Joined Oct 2007
Total Posts : 318
   Posted 3/1/2011 8:19 PM (GMT -6)   
No the HIPPA isn't cobra. It's a new type of insurance offered in Ohio for people who have exhausted their cobra benefits as I did and who cannot get insurance by any other means, including as a dependent or through a job as long as they have not had a lapse in coverage and their previous policy was a group policy. pre-existing conditions cannot be taken into account when computing the cost for it either. Only age, gender, smoking, and zip code determine your premium. It just started last year so i jumped on it when my cobra ran out. it's still expensive but cheaper than cobra was.

I decided to just assume my insurance will cover it since I don't need the job and i didn't really want it. My current job pays more and is only 5 minutes from home but they don't offer insurance to part time people like myself. (Even though i work 40 hours a week after 4 years they won't hire me full time, the boogers) If something goes awry with my current insurance then i'll just get back on the job hunt for a job i do want that offers insurance. Thanks for the replies!
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-J-pouch surgery scheduled 3/21/11

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 3/1/2011 8:44 PM (GMT -6)   
bestaronie~thanks for the education...I am in Ohio and had no idea that existed smhair
formally known as OHIO76 ~ honoring my daughter's passion!
Crohn’s dx 1989
some terrible years before my temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!
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