Question:
How long before I receive reply to Notice of Appeal

I have Aetna (HMO) insurance and was approved for a TT and had that surgery on September 24th. At that time, Aetna denied my request for Breast Reduction/Lift, Thighplasty and excess removal of skin from my back. I filed an appeal with them for these surgeries on Novmeber 15th and have not heard anything. I have not even received correspondence from them acknowleding their receipt of my notice of appeal (even though I received my green certified mail card back). Does anyone have any suggestions on what I should do? Should I start bugging them or wait a couple more days and/or weeks? How long after they receive my Notice do they have before they have to respond? I would appreciate any help in this matter.    — Carrie S. (posted on December 3, 2002)

December 3, 2002
I think that they have 30 days, but I would still start calling and bugging them. Sometimes it helps.
   — Vicki L.

December 3, 2002
Two things. First of all, get a copy of your policy from your HR Department and look in it for appeal procedures. The other is to call your state's Insurance Commission, Insurance Division or Department (it varies from state to state) and ask if there are any state laws governing appeals. No one else can really answer this question for you because it does vary from state to state and it can also vary from one policy to another, even if the policies are both from the same insurance company but are for different employers.
   — garw

December 4, 2002
Did you send the appeal to them yourself? I wasted 5 weeks because I did this with BC/BS and 5 weeks later I called them to check the status. I was told that it was basically dead-in-the-water because the appeal HAS to come from the surgeons office. They said I should have submitted my appeal letter and photos to the surgeon and he should have sent it all in for appeal. I asked why it laid around for 5 weeks and I wasn't notified and they didn't seem to have an answer for that. Anyway, I submitted it to the surgeon and they did the appeal about 4 weeks ago and I haven't heard anything yet. They said it would probably take 6-8 weeks. Good luck!
   — Lynette B.

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