What if you are caught between the appeal process?

Beth M.
on 8/20/04 9:17 am - South Vienna, OH
So far, I have been denied however, they have asked for a peer to peer review. This was on July 26. My pcp agreed to do so however, cited she would "have to find the time" and promised to do so. After seeing my surgeon last week and speaking with the insurance gal there, she inquired how the peer to peer thing went. I told her as far as I knew, it hadn't. She suggested I "follow up" with my PCP. I called my PCP Wednesday of this week and was told by the nurse that they hadn't forgotten me-haven't had much time. Said the doctor was going to try and come in early today (Friday) and get it done otherwise, it would have to wait until NEXT Wednesday. I told the nurse that if the doctor cannot get the decision reversed, I would have only 60 days to go to the second level appeal and I would have to hire an attorney to do this for me. I was sure the attorney would have me ask for an extension to that 60 days as well. Plus, rumor has it Aetna is going to stop paying for the surgery after 1/1/05. I told her that at the rate it was taking the doctor to do this, it was possible that just to simply complete the appeal process if the doctor could not get me approved COULD go beyond 1/1/05 and that I didn't know if a person in the appeal process and they quit paying could still GET approved. I encouraged them to do this peer to peer asap or I might be going through all of this for nothing! Does anyone know if you are in the appeal process if the insurance quits paying, do you still have a chance getting approved? Beth
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