HealingWell
Search Close Search
☰

insurance denying surgery, has this happened to anyone?

Support Forums
>
Crohn's Disease
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/26/2008 12:42 AM (GMT 0)
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???
Posted 6/26/2008 1:17 AM (GMT 0)
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!!
Posted 6/26/2008 1:43 AM (GMT 0)
(((((( 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!
Posted 6/26/2008 5:14 AM (GMT 0)
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.
Posted 6/26/2008 12:47 PM (GMT 0)
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!
Posted 6/26/2008 2:22 PM (GMT 0)
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
Posted 6/26/2008 3:46 PM (GMT 0)
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!!!
Posted 6/27/2008 11:16 PM (GMT 0)
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!
Posted 6/28/2008 2:12 AM (GMT 0)
Thanks for sharing the good news!! Good luck!
✚ New Topic ✚ Reply