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You are here: Experts > Health/Fitness > Health Care: UK > Medicare, Medicaid, Insurance, HMO problems > insurance refusal to pay for hip replacement
Expert: Adelaide Rose - 10/29/2009
Question
I am currently covered by my husbands medical insurance through his pipefitters local union #598. However, the coverage goes according to how many hours he has worked and since he has been unemployed for quite awhile, this insurance is due to run out after Nov.30th. I had my right hip replaced approx. a year ago, and am in need of having my left one replaced now. I had an MRI done on Monday and consulted my surgeon afterwards. During the consultation he told me that I could opt to have cortisone shots into my hip joint that would likely take the inflammation down and relieve the pain temporarily, but, the left hip socket was almost as bad as the right one was (bone to bone) and would eventually need to be replaced. Since my insurance is going to run out and due to the fact that I am going through a divorce and will no longer have any type of insurance after the divorce is final, I chose to go ahead with the replacement now and get it over with. I thought this was my choice? Since its my body and nothing is going to correct my hip problem, at the most would only put off the inevitable. Since I am on disability already due to RA and only have $900 per month coming in which has to pay for my housing and monthly medications, there's no way what so ever that I could ever afford to pay for the hip replacement myself. Having it done now and covered by the medical insurance that is still in effect is the only chance I have. The insurance company has denied pre-approval saying that it is not warranted at this time! Do I have any rights in this situation and is there anything I can do to be sure I get this replacement or am I stuck to just sit back and become a cripple? Please let me know if there is any information you may have or may be you can tell me who I need to contact for help? As I said before, I'm running out of time and of course its very cost effective for the insurance company if they can put me off until my insurance runs out and I'm no longer covered under their policy.
Thank you-
Dona Sullivan
Answer
Dona,
I would have your doctor write a letter of medical necessity (if it's warranted) and have the insurance company do another evaluation of the situation. The insurance company also have physicians that will look at your diagnosis, history, etc...and they too can make a determination of medical necessity based on your medical records as well as your doctor's letter.
good luck
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