With endometriosis, you might find it difficult to navigate insurance companies. For example, some great doctors might not accept your insurance and the insurance denies paying for their services. The insurance companies might insist that you go to their in network provider that is not an expert in endometriosis care. This situation needs some awareness and we need people to come forward and talk about their experience. Please share how your insurance impacted your chances of receiving care in endometriosis.
Endometriosis
Endometriosis in College: How to Take Care of Yourself When Life Doesn’t Pause
College is challenging enough when you’re healthy – throw endometriosis into the mix, and it can feel downright impossible some days. Classes, exams, and the
December 23, 2024
As someone already considered disabled before my endo diagnosis, I am on medicare for insurance. They won’t allow me to see anyone for Excision, let alone an expert, it’s all hormone treatments, go to a gastric specialist for a colonoscopy, have an ultrasound, if anything. I consider myself “lucky” my endo physically blocked a surgeon from reaching a surgical site as it is probably the only reason I was finally diagnosed, (it was with histologic confirmation, samples from the unrelated surgery were sent and confirmed to be endo adhesions and I had endometriomas on the ovary.)
After 20 years of unspecified symptoms, all it took was my 3rd opinion OB/GYN in 18 months to finally suggest a diagnosis behind those symptoms: Endometriosis. I started to research about an excision specialist after my doctor recommended that we rule out stage 4 endo. Once I started to review other woman’s struggle with symptoms that were identical to mine. And when I reached out to an out of state doctor who also practices in my state, they saw my condition as urgent. Her billing team assured me that they have a way to get insurance to cover everything because of the amount of medical history and severity of my debilitating symptoms. They submitted an urgent request for gap exception from ny insurance so I could get on her surgery schedule when she was in my state again. However, after 5 denials and appeals, they closed my case deeming it not necessary. But my doctor insisted on a peer to peer meeting to try and fight for me as well. I constantly spend hours on a daily basis calling insurance and asking about other providers that they suggest or what next steps need to me done for the to pay for my ideally life changing treatment. But my symptoms have gotten worse with they delaying the possibility for surgery for another 4 months until my doctor is back in my state. It seems that the insurance companies are not recognizing these sub specialists as medial providers. And the codes used to diagnose or bill don’t even exist or that they are too vague. No wonder women continue to struggle with pain that no one other than a mother know. But they energy that I do end up getting is drained after those calls. The lack of knowledge around endometriosis is alarming and if we are as progressive as a society you would expect science to catch up. Until then I will continue to fight for woman’s health and giving the insurance companies push back until we are heard and seen.