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-   -   insurance approving/denying surgery (https://www.neurotalk.org/thoracic-outlet-syndrome/153844-insurance-approving-denying-surgery.html)

pixified 07-19-2011 12:26 AM

insurance approving/denying surgery
 
I'm going to be having a rib resection/scalenectomy soon, but haven't heard back yet about whether my insurance is approving it. I have Aetna and they can be pretty conservative about treatment. Have any of you had problems getting the surgery approved? If so, what did you do? Also, have any of you with Aetna been able to get the surgery with no problems? Thanks.

DiMarie 07-29-2011 02:14 AM

Quote:

Originally Posted by pixified (Post 787822)
I'm going to be having a rib resection/scalenectomy soon, but haven't heard back yet about whether my insurance is approving it. I have Aetna and they can be pretty conservative about treatment. Have any of you had problems getting the surgery approved? If so, what did you do? Also, have any of you with Aetna been able to get the surgery with no problems? Thanks.

Aetna has been removed in our area of PA as a Medicare choice because of lax payments to providers and issues.
If I had any surgery that was considered elective I kept on them and documented the calls. Be a thorn in their side to how bad your life is and followup. Don't let them think you will go away.

I had to appeal several treatments for my family, or test over the years. In the end they were provided.
Good luck.

Sheri_TOS 07-29-2011 10:08 PM

Quote:

Originally Posted by pixified (Post 787822)
I'm going to be having a rib resection/scalenectomy soon, but haven't heard back yet about whether my insurance is approving it. I have Aetna and they can be pretty conservative about treatment. Have any of you had problems getting the surgery approved? If so, what did you do? Also, have any of you with Aetna been able to get the surgery with no problems? Thanks.

Hi! I understand your concern. I have Aetna insurance, too; however, Aetna wasn't my insurance provider when I had TOS surgery. I had no problems getting the surgery covered nor any of the rehab treatments. I have had several surgeries covered through Aetna and I think I received a letter from Aetna stating they authorized the surgery and hospital stay for XX days. Anything after XX days would have to be approved by Aetna on that day. You need to check with the doctor's office to find out when they submitted the paperwork and then check with Aetna. They seem to provide you with paperwork so you will have proof regarding their decision. They had a nurse call me a week before the surgery date(s) to see if I had questions/concerns and the nurse followed up a few days to a week after the surgeries.

tshadow 08-04-2011 06:19 PM

I had enough money to fly myself out to Denver to Dr. Annest who recommended surgery at his hospital. We took that in to the court in emergency and not only did I get repaid, she also set the surgery with the doc so we could avoid her games.

Now this was work comp - I don't know if you're talking a civil case against a party - usually they will give all medical right away to avoid higher medical.

Just don't quit. It has been 8 years for me, but I am not going to let them get me, (because I was a lawyer and judge) and they think it's a game. I may die but I won't go easy!


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