Question:
Just called Aetna and don't understand.......

I just called Member Services to see if they had my request and what the status was. She told me that it goes through a completely different deparment and she could not give me a phone number. She said that my surgeon is the only one who can call and check......doesn't that seem wierd???    — emilyfink (posted on May 7, 2002)

May 7, 2002
Hi Emily, My insurance (bekshire Health) did this also. They have another company that has what they call the "qualified staff" to determine medical necessity. Once they determine if it is or not it is then passed on to your insurance company to see if the type of procedure, in this case WLS, is covered under your particular plan. I would keep checking. Mine was improved in 2 weeks and I was told ove the phone but with all the paperwork between the two companies I didn't get the "official letter" for five weeks. Best Wishes in Your Journey.
   — Tammy B.

May 7, 2002
Email me and I can possibly help you.. I too have Aetna PPO OPEN CHOICE. I dont know if our paper work gets sent to the same place or not, but when I called Aetna to find out if they made a descision yet, they said that I would have to call their patient mangement department, I got a name an adress and a phone number.... If you are interested in my help please feel free to email me. I dont want to put that information on line as of yet.... I dont know if its Politically correct! I don't want to piss anyone off!! Talk to you soon, Californiakimmy
   — Kim S.

May 7, 2002
I too have Aetna and when I called to check the status they gave me the number of the precertification dept - which is where they determine if you meet the medical necessity criteria for the surgery. Any time you call an insurance company, if you don't get a person who can help you or seems willing to help you ask for their name, then call back - if you get that same person hang up. When you get a different person ask them the same questions - you would be surprised at how many different responses and answers you will get!! Tell them you just called but you are confused - could they please help so you can find out the status of your request? I call insurance companies to verify benefits all day (it's part of my job) and I end up educating their own customer service reps all the time - and I'm talking about several different companies - not just Aetna. Be persistent (but polite) - good luck!!
   — Kim A.

May 7, 2002
I also have AETNA open ppo and let me tell you about an run-around! I called constantly and was always referred to a different department--I found that speaking with an RN is the best way to get information. Check out my profile for my AETNA experience! Email me if you need any additional information.
   — jenn2002

May 7, 2002
I have Aetna/US Healthcare. When I was waiting ( I was tired of waiting after only 2 days...lol) for approval I called and they told me pretty much the same thing..."Client Services usually doesn't speak directly to members". Well as it turns out I was approved in less than a week anyway. My point is give them two weeks and see what happens.
   — Sandra C.