Newbie and Aetna issues

Hello all, My name is Heather and I live on the Eastern Shore.  I signed up for OH a while ago but haven't done much but read posts.  I've found an awful lot of helpful information and I hope that you experts can help me out with this situation.  My surgeon is Dr. Michael Schweitzer and we've been going back and forth with the insurance company for the last few weeks.  Teresa, the financial coordinator for Dr. S opened a case with Aetna and faxed the requisite information the second week in June.  I called a week later and Aetna had no record of a case being opened for me.  Had to have Theresa call again to open a case and re-fax the file, so that now I have an opening date of 19 June instead of 10 June.  Each time I call to check the status they are waiting for clinical information which has been faxed several times now.  I can't even talk with the case worker for my case - I'm told that she will only talk with the doctor's office.  I'm sure Teresa is sick to death of hearing from me and I feel awful about bugging her all the time. Has anyone had such problems with Aetna and/or have any advice on how to proceed to get this process pushed forward and completed.  I guess they don't care that it's only my life they are playing around with.  Sheesh!!

Lilly: Hi and welcome.  I know it feels like a lot to go through and I know I felt as if I was bugging the office staff.  Try to have all your questions in a row and call them once a day.  Then call the insurance company to see if they have what they need.  If not, call the office back.  It is your life and your health that you are fighting for!  Hang in there and it will get done!  By the way, we are starting a support group on the Eastern shore and our first meeting is July 10th at 7pm at the Denny's in Easton.  Your willing to join.  Let me know if you need more info! Keep us posted and good luck.

Hey Heather!!! Welcome to the Maryland Board!!  This is a great place to live or visit!!!  You'll find that we have a bunch of great Eastern Shore losers - in fact, we're gonna try to get together while I'm at the beach later in July.  There's a post on here about it - check it out, we'd love to meet you!! Unfortunately, I can't give you specifics about Aetna, but unfortunately, you're somewhat correct in your assumption that to everyone handling your case, you're just a number.  Why can't they get that it might be a routine part of THEIR jobs, but it's OUR lives?  Just keep pushing and document who you talked to and when, what they said and what the next step should be. Hang in there and good luck! Tia

Hi Heather!   Welcome to the MD board!  we're very glad to have you here :) I have Aetna and when I talked to them about my case, they were very friendly and encouraged me to keep calling back as much as I wanted when they received the initial packet of information from my doctor's office.  However, it was like an act of congress to get the doctor's office to send everything to the insurance company.  Remember, with Aetna (at least in my case) it takes from 15 to 30 business days for their nurse to make a decision on whether to approve or not.  Sometimes it's quicker.  I know the waiting is excruciating but hang in there hon!  things will start moving :)

Oh your situation sounds exactly like mine! I bugged Teresa to no end!! Here is what I would suggest ~ call Aetna and get the precertification line (find out their phone number while you have them on the phone). Have them read you the exact language about what is missing. Then if you have the document fax yourself. If you don't get in touch with Theresa.  I advise that you continue to check in regularaly and ask for detailed info as to what is missing. I did not and it spent weeks in a holding pattern until someone finally read the details and noted what was missing.  Do you have all the required documentation? If so, it's only a matter of time until you get approved (hopefully) but I know the waiting is the hardest part!!!

Thank you everyone for the welcome, the advice and the encouragement.  I had not heard that Aetna takes 15 to 30 working days to make a decision.  I'd heard that they are usually pretty quick, as in within a couple of weeks.  I'm trying to be patient but feel like I have to be on them daily.  Oh well....sooooon!!

I have Aetna. It took them 30 days (and at least 50 calls from me) to make a decision. I finally found a number at work that was a dedicated number to Aetna (not the one on my card) for our company to call. The rep I got found out the problem. The nurse reviewing my case was very part-time. She would pend the case every time she looked at a piece of information. She requested things from my surgeons office 2 and 3 times each. My company's rep escalated my concern to the nurses supervisor, and I was approved an hour later. I had called them every day, many days more than once, but all the regular CSRs would/could do is look at the nurses notes. They told me they were waiting on info from my surgeons office, and my surgeons office had fax confirmations that the info was sent, and received. Obviously, since I am 7 months post-op today, they did finally get it together. But, a month is a long time to wait!