Denied

So about a month after the crappy appointment I had several months back (posted here in the PS forum) - I found out that I had been denied by my insurance.  Did I hear it from the PS office?  No.  I finally called them after not hearing from them for about a month.  She said, oh - Aetna sent us a letter and said they had notified you, so we figured if you wanted to persue anything you'd contact us.  I never received anything from the Ins Co, so if I hadn't called - I wouldn't have known anything.

So I asked about the appeal and she said they would do anything on it - and was suprised that I wanted to try "You are really going to try to appeal?".  So I asked if I could have copies of everything she submitted to the Ins company so I would know where to start on the appeal. 

At first she told me she couldn't release anything to me...  Ummm, it's MY medical information!  I finally convinced her that she could and I said I would sign a release and everything.

So I give her a couple of days to get it all together like she asked and went to go pick it up.  When I get there, she says that she has a copy of the letter that the PS wrote, and a copy of his notes from my office visit, and a bad photo copy of the photos they took.  She said that was all they had, because they had "accidentaly" sent in the originals of the photos and letters they had from my other doctors (about rashes) and they didn't keep any other copies.

She did at least give me a half hearted sympathetic "Good Luck" as I was leaving...

I know I have to get with my other Doctors and get copies of the notes from the rash visits and their letters of recommendation.  I have pics I took of the rashes, because the Dr's offices I went to didn't do photo documentation....

Between the holidays and switching jobs (I'm a Federal Employee - so my Ins co didn't change with the switch) I haven't had a chance to go after the appeals process yet...  And I'm not 100% sure where to start. 

~sigh~

Hi, Sorry to hear this. It sucks and I am going through it also. I was going to rush right to an appeal and happened to call and ended up just talking to the insurance directly about it and found out exactly what was lacking from my submission and what to do next. Not sure where it will get me but you have to try ya know?

I posted here to and got some great advice about seeing other PS in network and other great tips...that's just a couple threads down from last week.

Anyway, so if you want start by calling and see if you can get them to agree to reconsider your case and discuss your denial with you in detail including what you can do to fix the original submission especially since you now have to clean up after your old ps office. Lol....I am cleaning up too Apparently some offices are way more equipped then others in dealing with these matters.

And keep on with getting all your ducks in a row like you have been... all the pics, documentation can only help.

Wish you the Best!
Laurie