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Re: surgery denied by medical insurance
From: anonymous (anonymous@obgyn.net)
Thu Sep 29 17:10:20 2005
Kara,
I had the same problem, and my insurance pays a very minimal amount
toward an out of network surgery (basically, they cover almost none of
it) but I decided that it was better to see a specialist and I am glad I
did because the doctor in my network did not find and remove endo. in
my first lap. but the specialist I saw did. So if you cannot get your
insurance to agree, and I think if they won't there is not much you can
do to make them, it might be worth doing what you can to try to pay for
the out of netwrok surgery if you are really confident about that
doctor. despite my huge medical bills I am glad I did it and got my
endo removed. Good luck! It's a shame that there are so many people
doing these surgeries when they are not really qualified to find and
remove all endo.
At Thu, 22 Sep 2005, MJ wrote:
>
>Kara,
>I am so sorry! You do not deserve to be put through this crap! I have
>had experience fighting w/ insurance companies, but nothing like
>this--in my case they had to pay...just dragged their feet and didn't
>want to. Hopefully one of the in network surgeons will be great.
>MJ
>
>At Thu, 22 Sep 2005, G wrote:
>>
>>Kara,
>>Oh man that sucks. i have never had to fight with the insurance company
>>like that. i am looking at endo specialists myself, but my insurance is
>>fine with an out of network doc. all i can tell u is to go with ur gut.
>>if u don't feel right about these other doc then i wouldn't have them do
>>ur surgery. (just my opinion) maybe one of them will be great! good
>>luck to u!!
>>
>>--
>>G
>>At Wed, 21 Sep 2005, Kara wrote:
>>>
>>>I had my 3rd surgery in 4/05 for an endometrioma, which was done by a
>>>local surgeon (near Albany, NY). This surgery must have been done
>>>incorrectly, because an ultrasound less than 4 MONTHS later revealed
>>>another (or the same) endometrioma in the same place. Naturally, I
>>>wanted to have another surgeon do this surgery. In late August, I saw
>>>another surgeon around Albany - a so-called "endo specialist" who did
>>>not believe that adhesions caused pain, a supra-cervical hysterectomy is
>>>unnecessary (he actually asked me, in condescending tones, if I was
>>>worried about losing my orgasms!), and that if I discontinued my birth
>>>control pills, the anti-prostaglandin effect of the hormones would last
>>>the 5 weeks until surgery (I have since asked 2 other surgeons and 3
>>>Nurse Practitioners - all who have never heard of this theory). Needless
>>>to say, I am not having surgery with this man. When I told my OB/GYN
>>>about this consultation, she was concerned about his surgical technique
>>>- and also that this was a surgeon who would never believe me if I had
>>>pain after surgery with him, especially since "adhesions don't cause
>>>pain". She was pleased that I was trying to contact a clinic in Atlanta
>>>that I had told her about.
>>>
>>>A week or two before I saw the above "endo specialist", I found the
>>>Center for Endo Care in Atlanta, GA on the web (they only do
>>>endometriosis surgery and care). I sent their doctors my records (10
>>>years of them!), and just after I saw the quack, one of the Atlanta
>>>surgeons called me and spoke with me for 45 minutes (for free, I might
>>>add - on a SUNDAY night!). I was really impressed with this Atlanta
>>>surgeon. He discussed how he performs complete excision of the endo,
>>>and how he has followed 1500 patients that he has performed surgery on,
>>>and that 85% of them are completely pain-free. Of course, he only does
>>>supra-cervical hysterectomies - and when I told him about the supposed
>>>anti-prostaglandin effect lasting 5 weeks - he replied, hesitantly, "I
>>>don't know what to say to that."
>>>
>>>I really want to go to the surgeon in Atlanta, but they are not
>>>participating providers in my HMO plan (a company called MVP). My
>>>OB/GYN put in an "out of network" request for me, which was denied. The
>>>insurance company states that there are other surgeons in their network
>>>that can provide the same care as the Atlanta docs (which, incidentally,
>>>did not include the above quack). I really doubt these in-network docs
>>>are as good as the Atlanta clinic, but I am now obliged to see these
>>>docs. I have appts set for next week. One doctor is only about 45
>>>minutes away, but the other doctor is about 2.5 - 3 hours away. I am
>>>really pissed that I am being required to see these docs. After my
>>>April surgery didn't help my pain, (and before my August ultrasound) I
>>>checked out both of these doctors. While they are both the heads of the
>>>OB/GYN depts of two large hospitals, they are NOT endo specialists. I
>>>plan to have consults with them both, ask them about their techniques
>>>and follow-up, and compare their answers to the Atlanta docs.
>>>
>>>I'm worried that I won't ask all the right questions. Also, what if
>>>they just give me BS answers - how would I know? Has anyone fought their
>>>insurance company before? Any suggestions would be greatly appreciated!
>>>
>>>Thanks!
>>>
>>>--
>>> Kara B.
>>>
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