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Originally Posted by JasonR
Good news! I was told yesterday afternoon that Aetna had reversed ActiveHealth's decisions to deny the surgery. Basically ActiveHealth was NOT following Aetna's guidelines even though they are owned by Aetna. It's taken almost 4 months but at least it went my way.
Now if the FDA would just approve the Bryan disc. Little birdie told me that approval is probably coming within the next month.....
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Aetna makes this way on purpose. They know this. But they want active health to initially deny and hope the client doesnt catch on. Here is another situation just like yours:
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"In short time my HR VP was asking our Aetna rep why it kept getting denied as experimental when it was FDA approved. Aetna denied the procedure again saying that the screening company, ActiveHealth, had correctly researched my issue and explained their decision.
At this point I found an Aetna policy bulletin that explicitly stated that ADR's were supported. My HR VP again demanded from Aetna how their policy could be so clear yet I be denied coverage. She was told that my case was being sent to a review board to ensure that ActiveHealth was making decisions in accordance with Aetna's policies.
3 long weeks later on the same day I let my VP know that I had sent my info to Stenum for review she emailed me back and said she was on the phone with Aetna and the denial had finally been reversed."
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They are DOGS , no they are SLIME! They know the game, they j ust hope most people give up after the initial denial. Its easy enough for aetna to tell active health that ADR is covered, hell, active health knows this too. You and I are just 2 of what is probably 200 cases a year where this routine, or shall we say , "dog and pony" show goes on. SO shameful they are!!