[gil]

I just had my first go-around with Aetna. I had seen a well thought-of Aetna participating surgeon who said I should have C5/6-C6-7 surgery and he does vertebrae fusion. He acknowledged that he is not familiar enough with ADR and recommended I see an ADR specialist for a second opinion. I could not find, and also an Aetna rep after 20 minutes of searching, could not find a spinal surgeon with ADR experience within 50 miles of my house - so I submitted going to a non-participating surgeon (Virginia Spinal Institute, Reston, VA). My request was turned down today. Interestingly, the non-participating surgeon cost less for consultation than Aetna pays participating surgeons.

I had to the call Aetna member line and state my case. Got a very good rep who actually called 5 surgeons in the Aetna list and try to find someone with ADR experience. She was unsuccessful and wrote a formal appeal while I was on the phone.

Just a note about initial reviews - many are done with customer service people looking at insurance company guidelines. It usually takes further appeals to get nurses and doctors looking at requests.

The big pain (pun?) is Aetna has 30 days to respond and will propably take all 30 days.

Is it correct that US surgeons can do two level ADRs but the insurance companies may only pay the cost of on level? Does anyone have experience with Virginia Spinal Institute, Reston, VA?