Topic: Can insurance change their mind about port surgery less than 24 hours before the time
tdtid
Frequent Contributor (1K+ posts)
Member # 10276
posted
We had been told that Insurance would cover 28 days or IV, the port surgery, visiting nurse, etc, and then we would be on our own.
We figured that would atleast get me in the door. We already have been working on the appeal letter and know the doctor was going to write a letter on our behalf as well.
But TODAY...less than 24 hours before my scheduled port surgery, they call to say they changed their mind and none of this is covered.
Basically back to I guess the fact that I had been on atleast 3 weeks of orals so I'm cured so don't need this.
If they approve it first, can they honestly change their mind about it the day before I'm suppose to go in?
I'm so upset and don't know what to do since I'm not sure we can really afford the surgery too on top of the nurses and meds.
Has anyone been denied the day before you were to go in for the port and if so, how did you handle it? Atleast if they denied we would have already started the appeal going, but the day before the scheduled surgery they first ok'ed???????
Advice? Guidance?
Cathy
-------------------- "To Dream The Impossible Dream" Man of La Mancha Posts: 2638 | From New Hampshire | Registered: Oct 2006
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I don't have any advice, but I'm so sorry to hear this...
Give 'em hell is all I can think of!
-------------------- "We must be willing to get rid of the life we've planned, so as to have the life that is waiting for us" - e.m. forster Posts: 921 | From PA | Registered: Jan 2004
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cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
I don't know about your state, but in my state (NC) the insurance companies can not only change their minds about preapproval
but they can also demand reimbursement for procedures that they approved twenty or more years ago. I called the insurance commission to verify that this was allowed,
and it is!
Posts: 1173 | From USA | Registered: Nov 2007
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posted
I believe they can, you're not the first person this has happened to. I've heard of people who were "preapproved" for major surgeries and once the surgery was done and over with, the insurance company came back and said they changed their minds.
This might be where you want to get an attorney on the line and get help legally. This sucks and I guess is the struggle so many people talk about with not getting the proper care for this disease. I'd fight it, and appeal it and do whatever you need to do to get this taken care of.
Posts: 215 | From Phoenix, AZ | Registered: Jul 2008
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tdtid
Frequent Contributor (1K+ posts)
Member # 10276
posted
Sadly, I should have been TOTALLY prepared for this since I have read this type of story over and over and over....atleast not getting the coverage.
Too many insurance companies only treating by IDSA guidelines, etc, etc, etc.
I guess I've been extremely lucky since I was on orals for 20 months and they never squacked once, so I was counting my blessings that our insurance was being so good, but perhaps I took the orals with no complaints for granted and thought they would be easier to work with regarding IV.
In any case, i did call Dr. R's office and they have been wonderful. They are calling the insurance company and trying to find out what else they want for documentation to prove I need this. Well, you know the drill.
I just don't know if I should be canceling this surgery tomorrow or go with it and then fight insurance like crazy.
The saddest part I find to all this is those of you with lyme living alone. I mean my husband gets the brunt of all this in fighting insurances, but when we don't feel well, we don't have the energy or brain cells to fight, so this is really so out of hand.
I was really didn't know they approve and then "change minds". This was a first for me, but I guess I've lived in lala land. I EXPECTED to be denied, but not the ole switcheroo.
Thanks for letting me vent. I'm sure that's all I really needed since I've been really upset.
Cathy
-------------------- "To Dream The Impossible Dream" Man of La Mancha Posts: 2638 | From New Hampshire | Registered: Oct 2006
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bettyg
Unregistered
posted
cathy,
HOG WASH BIG TIME.... PU! boy that stinks to high heaven!
cathy, contact NH's insurance commissioner's office; this was iowa's and i just changed the 2 letters for state at the end!!!
call this congress phone no....it's KENNEDY OPINION LINE that i call daily!! ******************************
202.225.2927 *************
tell them your name and complete mailing address, and that you want lyme bill PUT ON THEIR AGENDA NOW! ********************
then tell them what happened; it's 2 MINUTES to record. if you do NOT get it all told, call back, and ask for opinion line again to FINISH telling your whole story!!!
it's because of IDSA's 06 lyme guideliens that the CDC went along with and that the INSURANCE COMPANIES are using THAT WRONG info to DENY US INSURANCE COVERAGE and how wrong it is especially after they PREVIOUSLY approved this!!!
cathy, that's the best advise i can think of!!
best wishes and GIVE EM HELL!!! ******************************
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tdtid
Frequent Contributor (1K+ posts)
Member # 10276
posted
Latest update....
Going to go ahead and get the port but won't have any infussion company coming out tomorrow so will have to find a new one next week.
Insurance is CLAIMING they will pay for the port but my doctor is suspicious since why would you pay for a port for a medication you aren't approving. So whether they really will or not ... guess we will find out in the end.
So I guess one step at a time, but when you don't feel well, this is insanity trying to talk to all these companies on the phone. Usually my husband would be doing this but he's away on business and coming in late tonight.
I don't know how some of you have the strength to fight this. Amazing. I've done it ONE day and I'm crashing and burning and my anxiety has brought out the worst of my neuro symptoms, so I need to BREATHE and start growing up. Grrrrrr.
Cathy
-------------------- "To Dream The Impossible Dream" Man of La Mancha Posts: 2638 | From New Hampshire | Registered: Oct 2006
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posted
tdtid... your mailbox is full
Posts: 488 | From NY | Registered: Oct 2004
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bettyg
Unregistered
posted
cathy's surgery went well today said her post on her caring bridge site.
she did NOT have treatment due to insurance not paying, and they are fighting this.
hubby wrote a really nice informative note!
cathy is doing well; chest hurts but that is to be expected with the port. her neck was hurting too.
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bettyg
Unregistered
posted
momfromtexas,
i just posted on her new site; asked her to CLEAN OUT HER MAILBOX FOR PMS.... i couldn't send her either.
when she or hubby get on during daylight hours, i'm sure they will make room so you can pm her!
by your replying on this one, this will go to HER HOME EMAIL BOX TOO. so we've hit both ways so she cleans house, and you can give her advise! ************************************************
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