When Insurance Gets in the Way of a Needed Incontinence Surgery

Pete Health Guide
  • Recently I wrote about being your own advocate, and about letting doctors know how you feel about your condition and how they are treating it.


    I wrote that there is nothing wrong with letting them know if you think they have made a mistake, or that they are not doing something you feel they should be doing.


    I was going to write a post this time on the importance of thanking your provider when you do get good service and they have really helped you with your problem. It's just as important (may be even more important) to provide positive feedback, as it is to provide negative feedback.


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    However, I was recently disappointed when I was scheduled for a nerve block to decrease my bladder/voiding pain, the details of which may be the subject of a future post. I had one of these several months ago that showed some promise and so was scheduled for a repeat procedure.


    I arrived at the clinic, processed in, changed into a gown, and was waiting for the nurse to start an IV.


    Imagine my surprise when the doctor walked in and told me she could not perform the procedure!


    Although she had performed this procedure before, her billing department informed her that my insurance doesn't typically cover this procedure, and therefore she would not be allowed to perform it.


    This put her in an uncomfortable position of having to tell me, and she was really caught in the middle. She actually offered to do another procedure that would be covered, but we both knew it would provide limited and temporary relief, so I declined. My insurance would have covered it completely, but there's no point in charging my insurance for a procedure we knew would not help.


    I actually had a similar situation several years ago at another pain clinic. In that case the doctor cancelled the procedure because he didn't think I was getting enough relief. Same situation as this, got checked-in, paperwork done, gown on, IV started, and he cancels!


    This time I wrote a letter to the head of the clinic expressing my disappointment, not with the fact that the procedure had to be cancelled, but with the way it was handled. Someone had to have to known prior to my arrival that insurance was a problem and should have let me know. I was actually in contact with the clinic  a few days before the procedure, and I would have liked the option of possibly canceling the appointment and save the time off from work and the travel expenses (I live over 100 miles away from the clinic.)


    She called me, was very apologetic, and indicated she was not aware of the situation. She also said had she known, she would have authorized the procedure without assurance that my insurance would cover it. She also said she would have the doctor write me a personal note of apology. I told that was unnecessary, that the doctor had already apologized and that was enough, and that I didn't fault her. She promised the doctor would attempt the get the procedure covered and would look into why it was covered that last time.


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    I did write a personal note to the doctor, to let her know I was not upset with her, and to thank her in advance for attempting to get coverage. I think it was important to do this, to maintain the good relationship I have with her. As I've stated before, doctors are people too, and everyone makes mistakes.

Published On: May 23, 2011