Looking for Attorney in PA

[Odd_Bug]

Can anyone recommend an attorney located in PA that has experience handling insurance appeals?

Please help a long-time lurker!

(Husband with 15+ years of back pain, ADR candidate for L5-S1/ L4-L5)

[LBP]

I don't know any attorneys in PA but you might want to call the PA lawyers referral service, see the following link: http://www.pabar.org/public/membership/lrsblurb.asp

OR
PA health law project at: http://www.phlp.org/Website/whowearenew.asp

You might have to treat this like a networking situation. Call these orgs up and explain your situation and see if they can help or may give you a name of someone who can help.

Also you might want to look up a well known personal injury plaintiff's lawyers and see if he/she can refer you to the right attorney. some plaintiff's lawyers are really good a networking and giving referrals.

But in reality, I don't know if you will get much help going this route. Doesn't hurt to try and I don't know your situation, but a less expensive and easier route might be to get Aetna insurance. Chances of coverage go way up.

[Odd_Bug]

Thank you so much for your thoughtful response. I will check into some of those resources. My husband currently has Independence BC and I am covered through an Aetna HMO. We've been reluctant to switch because we haven't been able to get a straight answer on how "pre-existing conditions" are handled. The language on the PA Dept. of Insurance website is rather cryptic and I've been unable to reach a human there... If you have any info on making the switch, I'd welcome it. Thanks again for your reply!

[LBP]

well, I'm not sure all Aetna plans cover ADR. Are there any Aetna PPOs or PFFS plans at work. I might be slightly more nervous about an HMO plan. You might want to do a "find" search here to see if any other Aetna people were covered under an HMO plan. It seems most people with Aetna get coverage but I seem to recall at least one person here with Aetna that got denied.

I switched from a Cobra to a state ins program (when Cobra runs out) then to Aetna Medicare PFFS. I never had an issue with a pre condition because I went from one policy to another without any lapse in coverage. But I'm not sure if that is true for all cases and whether you might have to wait for 6 mos to a year before getting coverage. Your HR Ins person or the Ins Agent your HR person works with should be able to answer the "pre condition" issue but re whether Aetna HMO will cover ADR, that's an unknow but your odds probably go up from where you are now. If you've already been denied...how much does it hurt to switch over and try?

[Cirobi]

I'm not sure what the differences are anymore for coverage but I just moved from an Aetna HMO to their Choice POS II plan this past January. All of my insurance is through work and I know my current insurance version covered my ADR. I did however have a lot of issues when I was on the HMO with getting proper care from my primary care doctor. He blew me off as far as care went and then when I called and requested a prescription to go get an MRI they hesitated until I told them my insurance changed. I get the feeling they have a lot more problems with HMOs for some reason.

If you're able to go with a more open access plan it's likely to be worth it for getting better care on these more serious conditions. Aetna's been really good with everything for my ADR surgery so far, but then again it's not their HMO.

~Sara