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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #11  
Old 03-31-2009, 08:59 PM
sheljel sheljel is offline
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Hi Jason,

Aetna covered my ADR (Prodisc-C) on 03/06/09. Do you have a neurosurgeon working with you to get Aetna on board? My doc had my ADR approved from Aetna in one day.

Best of luck. Like others have said, don't give up.

- Michele
__________________
2001 MVA
2003 C6-7 Herniated - 3 Epidural Blocks
2004 C6-7 Fusion
2008 C5-6 Herniated; C4-5 Bulging; 3 Epidural Blocks
2009 Prodisc-C on C5-6 03/06/09 - covered by Aetna
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  #12  
Old 04-01-2009, 07:47 AM
JasonR JasonR is offline
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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.....
__________________
DDD C5/6. Incorrectly diagnosed as tension headaches in September 1997.
Nearly continuous headache since.
Began having pain in wrists in 2000, believed it was onset of carpal tunnel.
In 2005 pain began getting worse.
Diagnosed as DDD in July 2007.
Surgery recommended after 6weeks of PT made the pain worse.
ADR scheduled for Jan 26, 2009. Rescheduled for August 5!
Bryan disc finally FDA approved, and just in time too.
Neck was all jacked up and had to be fused unfortunately.
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  #13  
Old 04-01-2009, 10:47 AM
treefrog treefrog is offline
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That is good news Jason. I'm very happy for you. Now I will be hoping that the Bryan disc gets approved, and that Aetna will also approve using that disc for you.
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Cathy
MRI 12/07
L4-5 Mild-moderate disc degeneration with dessication.
L5-S1 Mild disc degeneration with dessication, minimal disc bulging.

PT/medication/acupuncture/ESI's/facet injection

Discogram 12/3/08 confirmed L4/L5 & L5/S1 as pain generators.
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  #14  
Old 04-01-2009, 08:02 PM
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steve55 steve55 is offline
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Quote:
Originally Posted by JasonR View Post
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.....
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:

Quote:
"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."
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!!
__________________
------------------------------
4/08- DDD at C5/6 & C6/7 & bulging discs. C5/6 portrusion.

6/08- Disco results- C6/7 painful, C5/6 popping sounds

7/08- Plasma disc decompression-significant relief obtained

11/08- pain returned to almost pre surgical levels

1/09 -Disco w/ Dr Ziglar shows C5/6 & C6/7 painful-2 level ADR recommended

2/26/09 - c4-c7 ADR Prodisc Nova with Dr Bertagnoli. 100% Success but need C6/7
ADR revision due to subsidence.
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