ANY HELP? - Im lost now

So Matt - what's the latest? Have you found anything out?

So far there is some hope........we wont know for sure until Monday. I called Aetna and spoke to them again and then I spoke to a healthcare advocate at Aetna for Lowe's (my employer). She at first said no the do not cover it, but then looked and saw that YES they do. She then called someone at Aetna and her manager and they too said that it was covered. We were all on a conference call and they said to send in my appeal, but I questioned that since that can take 180 days it says. Then the healthcare advocate got a little testy with the service rep since it was their mistake. She got back on the phone and said that the only reason they denied it was because it was at a non-network hospital. OMG another excuse! They have had many different replies on this but the denial just said it was not covered. We then checked the hospital and it WAS in the network! The surgeon's office wrote "New Britain Hospital" and it is actually called "Center of CT Hospital at New Britain" So now Aetna and the Dr's office are suppose to talk on Monday and reschedule me if it all checks out. I'LL BELIEVE IT WHEN I SEE IT. I refuse to get excited until the IV is in my arm and he is about to cut.

It might be time to consult a lawyer who can expedite any appeal review-- I fought long and hard with my insurer (the ever-ethical CIGNA) when they claimed after refusing to pay my surgeon that the approval had only been for hospitalization but not for surgery (which is why the hospital had been paid but not the surgeon).

I am sending you a PM about this....Jen

It sounds like a bunch of petty little errors - one by one - but the good news is it sounds like there is nothing to hold you back but paperwork and you'll be on your way soon enough - it just sucks that you have to endure so much frustration - the insurance industry can be so difficult! Keep us posted!

Matt, I fought Connecticare tooth and nail through 2006--even brought in a lawyer and the CT Insurance Umsbusman--bottom line--it was an exclusion. PERIOD--I was 42 years old, suffering from Congestive Heart failure--my cardiologist wrote several letters, all stating my death would be on their hands if they did not approve the surgery--bottom line, In January 2007, my employer changed insurance companies to one that covered WLS--almost all insurances will not cover WLS unless you have Co morbidities--it is not enough to be 100 pounds overweight anymore--My insurance agent however gave me advice that HELPED immensely -- after every conversation with your insurance company--ask for a "confirmation number"  this time stamps your conversation--and if you have proof--and someone in customer service told you the surgery was covered, they have to cover it--but without the conversation number you got nada...don't give up, if you were told it was covered--then you should have no problems--my approval came 46 hours before surgery! you are in my thoughts and prayers! Jennifer