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Old 09-26-2011, 01:55 PM
Merlinus Merlinus is offline
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Join Date: Sep 2011
Posts: 13
Default Aetna denied 2 level ADR

Received word at the 11th hour from Aetna via my doctor that they will approve a single level ADR only. Surgery was to be tomorrow 9/27/11, and they called the doctor friday 9/23/11. I've tried to discuss with the doctors staff and with Aetna - they make it their business to stonewall you. Now the doctors office has to reschedule surgery and resubmit for 2 level fusion.
My question to the doctors office was why can't I pay for everything over and above what Aetna won't cover? I can go after Aetna on my own after it's all done, right? The doctor said they don't have a problem with it but the hospital will bill Aetna for everything, period and the Aetna can deny the entire operation!? I'm scheduled to see the doctor 9/29 to discuss.

My company healthcare administrator will hear about this debacle. I work in the insurance industry, if we gave someone the kind of treatment that I've received I'd be hearing from our president's office having to explain why we PO'd our policyholder! We don't like those emails and do al we can to avoid them.
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8/2011- Cervical MRI report:
C5/C6: broad based posterior disc osteophyte complex causing thecal sac compression & cord flattening. Moderate/severe canal stenosis 9mm & bilateral moderate neural foraminal stenosis.
C6/C7: broad based posterior disc osteophyte complex w/ a small component eccentric to the rt causing moderate rt neural foraminal stenosis & mild lt neural foraminal stenosis. A moderate canal stenosis of 10mm.
On 10/18/11, two level C5-C7 ADR completed.
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