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Insurance Denying PART of Surgery
I'm wondering if anyone else has encountered this ridiculous denial and what, if anything, they were able to do to overcome it.
My doctor, one of the best robotic surgeons in the country, as part of his process does a special procedure on the urethra being tied to the bladder as to reduce incontinence and the need for any follow up sling or other solution after-the-fact.
My insurance says that since it's not demonstrated that I'm battling incontinence currently that this is not covered. I mean, they are already in there, how much extra time does this take?!?
I am waiting to hear from the doctor if they can do anything (since his notes are, apparently, what prompted this) and what the cost for that portion would be out of pocket.
Anyone else run into this type of BS?
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Update to this.
The doctor reached out to me via the portal and basically said "screw the insurance, we are going to do this and if they don't pay us then we don't charge you but we are not going to sacrifice your care for the sake of insurance approving or denying the best course of action for you".
That's not only pretty amazing but speaks highly that I chose the right doctor (again), the right hospital and am in the best hands.
For those interested in the procedure, it's called Urethropexy and is over 90% effective for preventing incontinence. This is generally done when you have a problem but some skilled surgeons can do this ahead of time and my doctor does this as a matter of course. I trust him, he's got many thousands of prostatectomy's and urethropexy's under his belt.
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4 ReactionsDoctors haven't been running medical care for quite some time. When I was young, hospitals were run by a Friday afternoon committee of doctors and that was all that was needed on the medical side. There was insurance back then, but a bill with no further info generated payment or often people had no insurance so they self paid outside something major. There was no such thing as 7 admin people for every doctor to do paperwork and fight insurance, hospital admin was tiny to nothing, then on the insurance side it was simple. It wasn't perfect back then but doctors had more say at least. Now it is mostly admin people having a say, and last time I checked admin people aren't very good at doing surgery, or caring for peoples prescription needs, or diagnosing disease, etc.
I had Tulsa Pro and paid for it myself, now some medicare code is out there who knows if it gets paid. No problems post Tulsa Pro here.
That’s great news…but he had to do it, actually. If he did not do what he recommended because you balked at payment and he wound up having a very unhappy, incontinent patient on his hands, he would have left himself WIDE OPEN to a negligence lawsuit.
He would have been sued for withholding optimal care. Not saying he’s not a great guy anyway, but he painted himself into a corner trying to get a few more bucks.
That’s health care and the legal system such as it is today. Best of luck with your procedure!
Phil