I want fibroid removal and mirena. Any advice?

[mozar]

After years of pain I finally found out what ails me and its just a stupid 4cm fibroid. It disrupts my life so I'd like to have it removed. I know I have a few options like myomectomy and embolization and something newer called radiation I think. My healthcare provider (cigna) won't give me estimates without the codes. I see a google ad that advertises fibroid removal, should I start there? I want it to be outpatient and combine fibroid removal with mirena insertion if possible to save money on the number of visits. Is this possible? I'm going to order my medical records because I forget what type of fibroid it is.

[ZiziPB]

Can't speak to the removal of the fibroid, but the insertion of Mirena and the device itself is fully covered under the new ACA requirements so it should be at no out-of-pocket cost to you.  BTW, I'm on my third one and love it.

[Trudie]

After years of pain I finally found out what ails me and its just a stupid 4cm fibroid. It disrupts my life so I'd like to have it removed. I know I have a few options like myomectomy and embolization and something newer called radiation I think. My healthcare provider (cigna) won't give me estimates without the codes. I see a google ad that advertises fibroid removal, should I start there? I want it to be outpatient and combine fibroid removal with mirena insertion if possible to save money on the number of visits. Is this possible? I'm going to order my medical records because I forget what type of fibroid it is.

Been there, done that.  To get pre-approval your physician can give you the codes so that you're speaking the same language as the insurance company.  I explored minimally invasive options and found that my insurer covered myomectomy and embolization, but not the ultrasound guided radiation (considered experimental).  Your physician can submit paperwork to make the case for you.  In the end, my situation was pretty significant and I didn't want to risk recurrence, so I had a hysterectomy.

[mozar]

What's pre-approval? I don't have a physician. I went to a gynecologist and she missed the fibroid. Then I went to a reproductive endocrinologist and she found it but her clinic doesn't do any fibroid treatment.

[Trudie]

What's pre-approval? I don't have a physician. I went to a gynecologist and she missed the fibroid. Then I went to a reproductive endocrinologist and she found it but her clinic doesn't do any fibroid treatment.

Pre-certification is the proper term.  Usually the provider or hospital can help you with this.  Before you schedule a surgery it's typically required.  If you're uncertain, ask at the hospital business office.

[mozar]

What if I want to do outpatient? I don't have a provider. I don't know who to talk to because I don't have a physician, my gynecologist was not helpful and the reproductive endocrinologist doesn't do anything with fibroids. Should I just call any hospital?

[MuttIsMyCopilot]

If you gynecologist doesn't handle fibroid treatment, she should be able to refer you to a doctor who does. I'd set up an office visit with that doctor to discuss potential options, and request the exact codes they bill for each procedure. Then you can call your insurance and find out what they cover. 

[mozar]

OK, I'm starting to understand. I found a hospital I can call.

[poppan]

No one will operate on you without an office consult first, so I think you need to look for a gynecologist who will be helpful and do the procedure. Bring whatever scan you have showing the fibroid or have the RE's office send the records over ahead of time. You go from there to schedule the removal.

[SunshineAZ]

TMI warning. 

I don't know how old you are, but in my mid-30s I had a small fibroid that was being "monitored", but within a couple of years it turned into 2 large fibroids and made my life hell.  I tried the embolization because I thought I was too young (and terrified) to have a hysterectomy.  Within a month of having the procedure, I started bleeding out the "pellets" that were supposed to cut off the blood supply.  I suffered with severe anemia for about a few years longer and then I gave in when I was seriously afraid that I was going to bleed to death in my sleep, and had a hysterectomy, but did keep my ovaries.  I did not realize how weak and miserable I had become until about 4 months after my surgery when I finally started getting my strength back.  The difference was amazing.   The loss of energy happened so slowly that I hadn't realized how bad I had gotten.  I never thought I would say this, but having a hysterectomy was the best decision for me.

If you are bleeding a lot, please keep an eye on your energy levels.  My anemia was so bad they had to check my blood before surgery and I was barely over the limit where they would have cancelled the procedure.  Oh and I was worried about my ovaries failing, but I have only started having menopause symptoms in the last year or so, and I had my surgery in 2008.

[mozar]

Well I would like to keep my uterus so I'm interested in myomectomy. I do have anemia when I get my period.
@poppan so a gynecologist will do the removal, not at a hospital?  My current gynecologist isn't helpful and I don't know if the reproductive endocrinologist will give me a consult about fibroid removal. Based on our conversations so far i don't think so.

[ZiziPB]

You need a new GYN who will handle the fibroid (or refer you to someone who will) and the mirena.  The endocrinologist should be able to recommend someone.

[mozar]

So the gyn will do the procedure? I've talked to 4 gynecologists and none have been able to help me and the last one said it was all in my head. That's why I'm doubtful a gyn will do anything for me. I called one hospital and they gave me the run around and I called a second hospital and I at least got an answering machine so I'll call back Monday.

I have to wait two weeks anyway because my company decided to change my insurance starting oct 1. I'll ask the endocrinologist if she has any thoughts on fibroid removal when I see her about egg freezing.

[ZiziPB]

What did the other 3 say?  How do you know you have a fibroid?  What are the gynecologists suggesting for treatment? 

[wenchsenior]

Presumably your fibroid was id'd with a trans-vaginal ultrasound, correct? I would think you need to talk to the gyn or endo who ordered that ultrasound, get a copy of said ultrasound report, and then get a referral through that doctor for surgery. Basically, whichever doctor diagnosed the fibroid needs to refer you, or you need to find another gyn or endo who will confirm with a new ultrasound and refer you.

[Kakashi]

All I want to comment is exploring different medical options is great.  However, you are just never going to control the costs which is part of the reason this was posted in the 1st place.  Getting surgery, there's hospital costs, bed costs, medication costs, anesthesia, etc.  Those are the major costs compared to just what the OB/GYN charges.  If you don't even have a doctor yet, then you have to go to consultations.  And if you are picky, you are going to have to goto multiple consultations to find one you like that will work with your situation. 

If you have a high deductible insurance, then do all your research now, and start in January.  Expect to hit your deductible and total out of pocket limit for the year.

Good luck

[abhe8]

Yes, the gyn is the surgeon who will do the surgery. You must find one,  make an appointment and discuss you diagnosis and treatment options. Outpatient surgery can be done in a hospital or a free standing surgery center, which may give a better price. Ask the gyn what their options are as far as locations they operate.

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[mozar]

1 didn't answer me, the other two thought it was endometriosis or pcos. The endo did a sonogram i think, not an ultrasound and found the fibroid and also did blood tests which confirm i don't have endometriosis or pcos.
So I have to go wherever the endo refers me? What if I don't want to? Or what if she refers me to someone out of network?

I can see that I can't control the costs, but I would like to know what the costs are, and I know the endo I went to won't be able to tell me because her clinic doesn't deal with fibroids and my health insurance won't tell me without the codes. I have an idea of what surgery I want (and would likely be recommended ) but I can't find out if it will be inpatient or outpatient.

Thanks abhe8.

 I know that its because of the horrible insurance situation in this country that everything is so opaque and people are so hard to talk to (the endo isn't returning any of my phone calls or emails either) so I'm fustrated.

[ZiziPB]

1 didn't answer me, the other two thought it was endometriosis or pcos. The endo did a sonogram i think, not an ultrasound and found the fibroid and also did blood tests which confirm i don't have endometriosis or pcos.
So I have to go wherever the endo refers me? What if I don't want to? Or what if she refers me to someone out of network?

You don't have to go to any specific doctor.  You just need to find a doctor who agrees with your endo's diagnosis and is willing to treat it the way you want.  Unfortunately you are the one that needs to to all the legwork here. There are no shortcuts.

[Choices]

Sorry you're getting the runaround, mozar.

Here are some CPT codes for myomectomy, but the price will vary depending on which one is chosen. https://www.supercoder.com/coding-newsletters/my-ob-gyn-coding-alert/new-myomectomy-codes-require-complete-documentation-to-ensure-proper-payment-article

Your gyn might also choose to do a different procedure entirely or try to control your symptoms with medications, so it's definitely worth a consultation to discuss your options. Whether you want to have kids in the future is another important question you'll want to discuss.

Then there's also the facility charge and other various add-ons as already mentioned by others. Do you have a high deductible? If so, waiting until Jan is a good idea. If not, then you might as well get things started now. Finding a good ob/gyn can be tough, but don't give up! Do your friends or family have any recommendations?

What about your primary care doctor? It's good to have a specialist who gets along with your PCP because they'll communicate better and you'll get better care.

Also, sonogram and ultrasound are synonyms. In an imaging center or an emergency department, they're usually formal studies for which you can obtain the radiologist's report as well as a disc of images. However, if your RE just did one in the clinic, there might not be any saved images or report, so your new gyn will have to repeat the imaging.

Best of luck.

[Beriberi]

This might be repetitive, but if wanted to post to make sure it is clear...

The decision to have a procedure  (including what type of procedure) is between the person performing the procedure and the person receiving it. 

So, you need to determine who will perform the procedure before you will know exactly whet the procedure will be.  I would choose someone in your preferred network who operates out of a free standing day-surgery center. You then should be able to call that person and schedule an appointment (and bring all of your records). That person will make a recommendation for treatment. You can discuss with your insurance what that will cost.  If you do not agree with their recommendation, you may seek care with another gynecologist and repeat the process. 

Of note, a REI doc does not do the procedures necessary for treating fibroids, so cannot counsel you on what you might need.  He/she should be able to refer you to a colleague that is trusted, though you should be able to choose anyone you like. 

I would be open to the idea that your symptoms may or may not be related to fibroids.  There is no blood test for endometriosis, and many large fibroids are asymptomatic.  Approaching a gynecologist with the story that 4 gyns have so far failed you may label you as a difficult patient.

[Zamboni]

http://www.medstarwashington.org/our-services/womens-health/conditions/the-fibroid-center/#q={}

https://www.gwhospital.com/conditions-services/womens-services/fibroid-menstrual-disorder-center

You need someone who does a lot of fibroid surgeries . . . that is who you need to talk to about this. Your run of the mill OB-GYN is not what you are looking for here. Good luck!

[RetiredAt63]

I would be open to the idea that your symptoms may or may not be related to fibroids.  There is no blood test for endometriosis, and many large fibroids are asymptomatic. 

This.

I had extremely heavy bleeding during my periods.  First diagnosis was fibroids (ultrasound).  Second diagnosis was fibroids that were not causative, and adenomyosis that was causative (adenomyosis is much harder to identify, that ultrasound was at a teaching hospital).  I was anemic from the heavy bleeding.  First suggestion was a hysterectomy, second was the Mirena.  The Mirena stopped the bleeding (no periods), iron supplements solved the anemia, and I was fine.  A Mirena is a lot easier than surgery, and if it works you are set.  If it doesn't work then there is always surgery as the backup plan.

[Zamboni]

I hope you have a chance to see a specialist for your issue (sorry about the links, but I remembered where you lived from posts about your Dad I think? Probably I should have pm'ed those.)

I had problems with Mirena . . . and others have had problems as well (such as anxiety, insomnia.) My OB-Gyn had seen that with women enough that she immediately took it out when I mentioned this and the problems disappeared. Everyone is different and lots of women are happy with it, but please just be aware that it isn't a cure all. I never had anxiety or insomnia problems before Mirena, and I've never had any problems since it was taken out. But during Mirena . . . OY!

[Sibley]

Mireya has a small amount of hormones in it, which can for some women cause side effects. However, it's the hormones that result in reduced or no periods.

[wenchsenior]

Re: Mirena. I have not used it, BUT if the OP has any issues at all related to elevated androgens (such as with Polycistic Ovary Syndrome), this is not the type of synthetic progestin (levonorgestrel) recommended, because it has an androgenic effect. There are other types of synthetic progestin that don't have this effect, and they might be better. It doesn't sound like that is an issue for the OP, but just in case.

[mozar]

Thanks all. A lot to chew on.