Question:
Who should I listen to? the insurance people or the Dr.'s Office???
I have AETNA/US Healthcare HMO... My paperwork was sent on Oct/31/02, since that date I've been calling almost every day to both, the insurance co. and the Dr.'s office. AETNA is telling me that they don't see any request or paperwork been file under my name. I explained to them that what I needed was the approval for WLS, then they tell me that even though they don't seen nothing in their compurer, the correct procedure is to have the Dr.'s office call them to pre-certified me and then is when they open a case for me. Then I called the Dr.'s office and explained to them what AETNA have told me, to what they tell me that they don't need to call anybody since this is what they do everyday and that's not the way they do it. That AETNA will update my information once they either approve or denie!!! Please somebody HELP ME!!!! I'm desperate!!! — ELIZABETH ROMAN (posted on November 10, 2002)
November 10, 2002
Hi... this sounds right to me. I made several calls to my insurance co. and
every time I called it would be someone different I talked to. Heard many
different stories for meach of them. But actually, they will keep telling
you you are not in their system. That is because your info will not be put
in their system untill a decision has been reached. The last time I called
the insurance, they told me my info had been put into the system just the
day before... that was on a Friday... by the following Monday, I recieved
my letter of approval! So, just be patient... it took my insurance about 4
weeks to approve me.
Good Luck!
Sheryl
— Sheryl W.
November 10, 2002
I have Aetna Usaccess and they needed my medical records and letter from my
PCP with proof of diets before they would approve. Once my surgeons office
got them the paperwork I put together for them my approval was quick.
— TerryLee J.
November 10, 2002
Just to let you know, I have been through the same ordeal. I call the Dr's
Office and they tell me that it has been sent and a week later I call the
insurance company and they say they have nothing. Everyone at the
insurance company tells you a different story. The people that these
insurance companies hire make little more than minimun wage and just want
you off the phone. They will pretty much tell you anything. They are not
even required to have a high school diploma. Believe me I used to work for
one during college. More than likely thay have recieved your papers and
the Doctor on their staff is reviewing your case. It does take a while.
They make sure all of the "t's" and "I's" are crossed
and dotted. I would just keep trying back every other day until I found
out something. That's what they are there for...Good luck...Ned
— Ned S.
November 10, 2002
If the issue is money, then your insurance company is your God! Be
soooooooo careful. Get ALL in writing. That's all I can say.
— Debby M.
November 11, 2002
I have Aetna US Healthcare as well, but mine is PPO. Basically they told me
the same thing when I called. They said they had no information on me, but
the girl I spoke with was really nice and asked me which address we had
sent the info to. I guess there's the one place in South Carolina for
general stuff, and there's another place in another state where pre-cert
info gets sent. She gave me the address and such for that one and told me
to have the Dr. send my stuff to that address. So, we did. They have it
right now, and had requested more info to be received by today. So,
obviously it worked by sending it to the other address, because if it's
sent to the NC address then they have to forward it to the pre-cert
address. Who knows how long that takes or if it even makes it! But, I have
also been told my Dr.'s office that it is common practice with Aetna to
tell you that they haven't received it. If you need that other address
e-mail me, and I'll get it for you. Don't know about what to tell you about
the doctor's office, maybe you can get them to tell you which address they
sent it to, and explain about the other address. Good luck! -Autumn
— autumn F.
November 11, 2002
Hi. We've got Aetna USHealthcare also, but the PPO. Our dr office handled
everything. I called Aetna once and got the same run around. The dr
office advised to let them deal with the ins, because they know the
"right" ways to word things, etc when talking to the ins co. We
both ended up being approved. I think it took about 6 wks. Good luck!
— Monica & Chuck C.
November 13, 2002
I had my surgery 05/13/02 and I still have not heard from Aetna saying that
I was approved. So evidently you don't have to get a letter or a phone call
saying you were approved. My doctor's office called me 2 days after I left
my first consultation saying that Aetna had approved my claim.
— MURRAY
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