***Insurance Help--I have Aetna PPO through City of Seattle***

lori86
on 9/15/03 7:59 am - Bothell, WA
Hello, I am having the worst time with my insurance and need any and all advise from anyone who has been where I am. So far it has been a nightmare. Aenta doen't have anything against having the procedure but our PPO plan is through my husbands employer and the City of Seattle. They are the ones who specified in their contract that under no terms was this procedure to be approved. After making several phone calls to his employer and to the city benefits office I found out that they couldn't even believe this was in the insurance contract. In talking with Aetna on how to appeal them denying a pre-approval they said because of the contract the City of Seattle has and that they specifically state they will NOT cover this that they, Aetna, would just instantly deny mine and/or my doctor's appeal. That no matter what my medical necessities were they would deny it. I asked them even if my medical conditions were life threatening and caused by this extra 100+ pounds they still wouldn't accept the appeal and appove it. They said no. It doesn't matter that it would be a life or death situation. I am amazed at how much we spend every month and for the pas 15 years into our medical plan and when I need the most because of medical reasons they refuse to cover my operation. I am not giving up yet. I am going to contact every department in the State of WA. For example, The Insurance Commissioners office, Human Rights Commission, etc. I am also going to work very closely with my doctors when I submit my appeal. If anyone else out there has an Aetna PPO plan through the City of Seattle and was able to win their appeal please email me at [email protected]. I need all the help and advise I can get. I will keep you updated on my progress.
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