The Road to Surgery: Part 1

My goodness, this has become a legitimate saga.

If you've read my recent articles about my reproductive issues, they ended on a cliffhanger: the total laparoscopic hysterectomy and salpingectomy that I was all set to go through in July 2023.

My friends... oh, my friends. Believe it or not: It didn’t happen.

A frustrating insurance denial

Less than 48 hours before the surgery was scheduled to be performed, I was told that my insurance denied the procedure.

W.T.F.?

The office waited until the last possible second to send in the prior auth ("Our policy is to send out prior authorization 1 month before") and it was DENIED. Please explain this to me. This surgery had been scheduled since February 2023, and they waited until June to send in the prior authorization? What if the claim was denied? It would give them time to send an appeal, and for my surgeon to meet with the insurance doctor, before said surgery.

You know what’s even worse? The person in billing laughed and said, "Yeah, your insurance doesn’t like to cover this surgery." If you knew that, then why not start this process earlier?! I wanted to sue.

Waiting for surgery impacted my RA management

This story gets even crazier: I received the denial letter. Insurance denied the surgery because I had not tried talk or physical therapy.

Yes, I was bleeding 21 days of the month each month because I was depressed and anxious (I have neither depression nor anxiety). Physical therapy would absolutely untwist my uterus. I know medicine has come a long way, but dang! I had no idea that PT was that effective! (Sarcasm.)

Okay, fine, whatever, I had to wait for surgery, but probably the biggest wrench in the gears was how it affected my rheumatoid arthritis.

Stopping my RA medications

In the month prior, I had to stop my TNF blocker, Orencia, and, unfortunately, my subcutaneous DMARD injection, methotrexate.

Given my medical history, I only had to hold the methotrexate 1 week before and 1 week after the surgery; however, due to an infected tooth removal, a root canal infection, a sinus infection, and yet another UTI, I was on antibiotic after antibiotic to clear all of them up before surgery. That meant I had to hold off on immunosuppressant meds and increase my steroids.

Intensified autoimmune symptoms

If you have RA (or any chronic condition), you know the importance of staying on your prescribed medications. I was in very bad shape, autoimmune-wise. My joints were swollen, my blood work was off the charts, and I became less mobile. The only silver lining was that, yes, it was the summer and I was not taking classes, so I could take it easy.

The second I heard the surgery was cancelled, I called my rheumatologist’s office. They got me in immediately for my monthly infusion, but even though I got back on it almost immediately, I’m sure you are aware how missing a dose (even by a week or 2) can wreak havoc on an immune system. It’s like the body is waiting for any opportunity to go haywire again.

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A long-awaited approval

I was so angry. Over the next 2 months, my surgeon attempted to call and secure an appointment with an insurance doctor. They kept leaving messages hoping that someone would finally call them back. In the meantime, I tried to undo the damage of pausing my meds.

At the beginning of August, I received a call from the PA. My surgeon met with the insurance representative, pleaded my case, told them how physical therapy and depression medications would not work for me (I mean, that’s just common sense, but since when do insurance companies use their brains?) and got my approval. The surgery was scheduled again for October 2023.

And, I know you want to know... The surgery happened! I will share my experience and what I did to ensure a somewhat seamless recovery in an upcoming Part 2.

Have you ever experienced insurance woes like this? Share in the comments!

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