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Suggest Treatment For Severe Endometriosis
Question: Hi Doctor, Can anyone help me in understanding the treatment process followed for my wife?
My wife was having sever pain at Menstrual Time and also irregular periods from past 6 months and the pain was getting increase month by month. i am assuming this issue could be there before 6 months also.
when we consulted a related doctor she had had advised to go for a laparoscopy surgery where she can remove the cysts. This was the procedue which she had followed "Laparoscopy, Overian Cysts Removal and Adhesiolysis". As she could not reach the Cysts she had done the laparoscopy and Adhesiolysis and gave leuprolide injection to reduce cysts.
My Concern here is I had gone for a medical reimbursement for this treatment, but the insurance guys have rejected my claim saying this procedure comes under Infertility, but my case here is related to the pain which my wife is having at the time of menstural time and also i have a kid of 6 yrs. so i need clarification on if we have kid will this procedure is considered as Infertility?
Thanks in Advance for the response
My wife was having sever pain at Menstrual Time and also irregular periods from past 6 months and the pain was getting increase month by month. i am assuming this issue could be there before 6 months also.
when we consulted a related doctor she had had advised to go for a laparoscopy surgery where she can remove the cysts. This was the procedue which she had followed "Laparoscopy, Overian Cysts Removal and Adhesiolysis". As she could not reach the Cysts she had done the laparoscopy and Adhesiolysis and gave leuprolide injection to reduce cysts.
My Concern here is I had gone for a medical reimbursement for this treatment, but the insurance guys have rejected my claim saying this procedure comes under Infertility, but my case here is related to the pain which my wife is having at the time of menstural time and also i have a kid of 6 yrs. so i need clarification on if we have kid will this procedure is considered as Infertility?
Thanks in Advance for the response
Brief Answer:
This is not related to infertility in your situation
Detailed Answer:
Hi,
I understand your concerns.
Following is my reply :
1) She is suffering from severe endometriosis.
2) Endometriosis leads to adhesions in abdomen and pain during menstruation.
3) Endometriosis ovarian cysts could not be removed due to the presence of severe adhesions.
4) Generally such severe endometriosis is associated with infertility and hence insurance company has got confused.
5) Write to them again explaining you have a baby and this procedure is not related to infertility in your situation.
6) They have to reimburse. Appeal this.
Let me know if you need anymore help.
This is not related to infertility in your situation
Detailed Answer:
Hi,
I understand your concerns.
Following is my reply :
1) She is suffering from severe endometriosis.
2) Endometriosis leads to adhesions in abdomen and pain during menstruation.
3) Endometriosis ovarian cysts could not be removed due to the presence of severe adhesions.
4) Generally such severe endometriosis is associated with infertility and hence insurance company has got confused.
5) Write to them again explaining you have a baby and this procedure is not related to infertility in your situation.
6) They have to reimburse. Appeal this.
Let me know if you need anymore help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor,
Thank you for your response,
Below the response which i had got from the doctor who is a consultant in Insurance company. my claim got rejected at two different times. below is the response to the questions which i had asked to the insurance guy.
"Mrs. XXXXXXX admitted at motherhood hospital 31/3/16 and discharged on
1/4/16 , diagnosed endometriosis for Laparoscopy and procedure.( cause for pain abdomen/irregular bleeding)( Planned for laparoscopic ovarian cystectomy + Adhenolysis ) On the table due heavy adhesion's ovarian cystectomy not done and only adhenolysis done.
During PA check-up Anaesthetist in his record mention pre and post anaesthesia ovarian cystectomy done( the reason not known), hence there is conflicting statement from anaesthetist , hence denial for cashless.
On reimbursement treating doctor has clearly mentions due to adhesions ovarian cystectomy not done only adhenolysis done ( due extensive
endometriosis)
Claim is rejected on the basis of infertility clause ( Secondary
infertility)"
2nd time my claim got reject on the basis of infertility clause( secondary infertility), so my question here is do we have any such level of infertility like first or secondary infertility?
the doctor who had operated had given a covering letter. so can you please check that and let me know whether i'm eligible for claim. please find the uploaded letter for details given the operated doctor.
Thank you for your response,
Below the response which i had got from the doctor who is a consultant in Insurance company. my claim got rejected at two different times. below is the response to the questions which i had asked to the insurance guy.
"Mrs. XXXXXXX admitted at motherhood hospital 31/3/16 and discharged on
1/4/16 , diagnosed endometriosis for Laparoscopy and procedure.( cause for pain abdomen/irregular bleeding)( Planned for laparoscopic ovarian cystectomy + Adhenolysis ) On the table due heavy adhesion's ovarian cystectomy not done and only adhenolysis done.
During PA check-up Anaesthetist in his record mention pre and post anaesthesia ovarian cystectomy done( the reason not known), hence there is conflicting statement from anaesthetist , hence denial for cashless.
On reimbursement treating doctor has clearly mentions due to adhesions ovarian cystectomy not done only adhenolysis done ( due extensive
endometriosis)
Claim is rejected on the basis of infertility clause ( Secondary
infertility)"
2nd time my claim got reject on the basis of infertility clause( secondary infertility), so my question here is do we have any such level of infertility like first or secondary infertility?
the doctor who had operated had given a covering letter. so can you please check that and let me know whether i'm eligible for claim. please find the uploaded letter for details given the operated doctor.
Brief Answer:
Claim not possible if infertility is mentioned
Detailed Answer:
Hi,
Secondary infertility is not mentioned in doctor's covering letter. Have they mentioned secondary infertility or Ovarian cystectomy in files? If yes, your claim is not possible as written by insurance company inspite of this covering letter.
Claim not possible if infertility is mentioned
Detailed Answer:
Hi,
Secondary infertility is not mentioned in doctor's covering letter. Have they mentioned secondary infertility or Ovarian cystectomy in files? If yes, your claim is not possible as written by insurance company inspite of this covering letter.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor,
please find the attached report from the concerned doctor. Is Ovarian Cystectomy is related to infertility?
Thanks,
XXXX
please find the attached report from the concerned doctor. Is Ovarian Cystectomy is related to infertility?
Thanks,
XXXX
Brief Answer:
Not always related
Detailed Answer:
Hi,
Ovarian cystectomy is not always related to infertility. Especially in your case it was for pain she was suffering from.
Doctor's present letter clearly states no cystectomy done. Please reapply with doctor's letter.
Not always related
Detailed Answer:
Hi,
Ovarian cystectomy is not always related to infertility. Especially in your case it was for pain she was suffering from.
Doctor's present letter clearly states no cystectomy done. Please reapply with doctor's letter.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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