DENIED NEED HELP!!!!!!!!!!!!!!!!!!!!
Christine,
I am so sorry to hear this. Please share your story! I just completed Aetna's 3-month regimen also and am waiting to hear from them (paperwork submitted two weeks ago).
What was the reason they gave in their denial letter? Are they now saying 3-months isn't long enough? Do they want you to do 6-months?
Keep your chin up - I have a feeling everything is going to work out for you, in some way.
-Christine
Christine,
I was just reviewing your profile and was reading over the section where you listed Aetna's requirements for the 3-month multi-disciplinary pre-surgical regimen. I didn't see where you listed behavior modification, which is one of their requirements. Did you complete that part?
Saying a prayer for you!
I am so sorry Chris, I know this must be tearing you apart. Can you share with us Aetna's reason for the denial. I know my insurance sent me a very detailed denial letter which I forwarded to my pcp so we know "exactly" what to provide them with. So I am going through yet another 6 month dr supervised diet. I am 2 months in and 4 months to go. Keep me posted and you are in my prayers girl!!
Christine,
I have Aetna and I was denied by them also. You really need to discuss this with your surgeon. If you are doing the surgical preparatory regimen, the surgeon needs to give Aetna information about it. It may be that you were denied for a reason that is out of your hands. What was the reason stated for the denial? You do NOT need to do an appeal just yet. Calm down so you can think straight! Call your surgeon's office. Your case can be submitted for reconsideration, and then move to appeals if necessary. Before it's submitted for reconsideration, make sure that you have everything in order and give them exactly what they are looking for. Sometimes denials will be issued because they "think" they have not received all the paperwork. You have the right to get the criteria that they used to make their decision about the denial. This will tell you EXACTLY what was missing.
irene
Thanks guys..however...my problem is I think Aetna used the wrong criteria in their process...they used their orig criteria of 6 month diet and exrecise guidelines instead of their Mutidisiplinary guidelines..and not one person seems to understand that ...I feel as if I am speaking Chinese to them...
Christine
This is not as difficult to fix. Call the precertification department and refer them to CPB#0157. Have a copy open on your computer while you are on the phone with the person that handled your case. It is very important that the nurse that denied you be pointed out this information. When you got a letter of denial, it came from a nurse and was "rubber stamped" by a doctor. Even if you don't know who issued the letter of denial, trust me the precertification department will know! Tell him/her that you don't understand why you were denied since you met ALL the criteria in their published Clinical Policy Bulletin.
irene
P.S. Don't forget, Christine, that Aetna do NOT want summaries. They want DETAILS, in the form of chart notes, etc. This could also be part of the denial, and if so, you'd have to take that up with your surgeon's office.
Ok ......
After hours on the phone with SEVERAL AETNA REPS..I have finally got it thru their head that there is indeed another part to their policy..my case manager told me to resumitt for a review with a letter clearly stating that I wanted processed under the guidelines of the Mutidicipinary Surgical Prep regimen...I am also going to add another letter from my PCP and copies of my records from him...
I also called Partnerships today and they said they would help with an appeal....Mary Meola is the Guru of appeals...
So bottom line..should I resubitt with this documentation or wait for Mary to Appeal...HUMMMMM Can anyone help?
Most Active
Recent Topics
