URGENT - Need Aetna multilevel precendent for appeal

[lizey p.]

Hi, all --

On 5/25/07 I had 3-level ADR (ProDisc, L5/S1 - L3/4) and it was a huge success -- I feel incredible. Now I'm embroiled in the insurance battle over coverage. Despite having paid for multilevel ADR for other patients, so far Aetna refuses to pay anything. My second-level appeal is due next Tuesday, 1/15.

My lawyer feels the critical piece to winning my appeal is finding precendent, so I am writing to ask anyone who has had Aetna cover multilevel ADR to please reply to this post and/or send me a PM and/or email me at elaffin@adobe.com ASAP if you are willing to speak with me. I would sincerely appreciate it.

I have already searched the boards and PM'd the three members I could find who posted about Aetna covering their multilevel procedures.

Many, many thanks, everyone!

Eliza

[LBP]

have you been in contact with BB? if you do a "find" for aetna you'll see his post of Aetna coverage for 3 level by delamarter in '06

[lizey p.]

I did, thanks. Replied to his post and sent him a PM. Thanks for the suggestion!

[BB]

Aetna did pay for my three level surgery. However, I had an Aetna policy that allowed me to go outside Colorado. The hospital was also in the Aetna network. My surgery was approved under the label of "compassionate" surgery. I believe this was through the FDA... The first disc was approved and labeled Prodisc and the other two were off label (or something to that effect)..

[lizey p.]

BB -

Would you be willing to discuss offline? Any examples of Aetna paying for multilevel regardless of the details of the plan under which payment was made are extremely helpful. An example of "compassionate care" would be extra helpful, actually, as that is part of the argument I am making in my appeal. If you'd be willing to help, please email me at elaffin@adobe.com. My appeal is due 1/16 but even late correspondence is generally accepted and may help. I would deeply appreciate it if you'd be willing to talk.

Thank you!
Eliza