Paid cash for ADR because Aetna denied me

[mattshell]

Has anyone paid cash for ADR after Aetna Denies claim and succeed in reimbursement from Aetna ?

[steve55]

Yes, I knwo of one person who was approved multi level ADR, and I sent my multi level ADR appeal into Aetna 3 weeks ago, waiting to hear back now.

[steve55]

I was declined. I spoke with an attorney who had handled many single level ADR cases and he says precedent carries little legal weight. Insurance co's are not bound to approve people for a procedure based on precedent alone. He says I could have 50 cases of precedent and they dont care.

Laurie Todd was kind enough to write me back and said:

" I am so sorry that you lost your appeal.

Even I don't win every appeal. As of now, I have won forty-eight, and lost two.

One of the appeals that I lost had seventy-one cases of precedent, thousands of peer-reviewed medical journal articles, and the expert surgeon had performed 1600 of them. The appeal that I won last week was a surgery for a condition that is so rare that the expert surgeon had only ever done seven surgeries for it, I had NO cases of precedent, and there had only ever been ONE journal article ever published about it.

The appeal that I lost was eighty pages long, and the appeal that I won last week was twenty-five pages long.

In the book and the CD, I have described the writing and fighting of an appeal as best I can. There is, I suppose, an indescribable element of attitude, strategy, tone ... an underlying something that turns the tide."



American health Insurers are nothing short of crooks. Good luck fighting them, you'll soon find out you have no power.

[ans]

I am so sorry about this. A while back, your insurance company seemed to be ADR-friendly. What happened?

To the fellow who posted to you (sorry, pulling an all-nighter/stupid/lazy), congratulations. Man, I'd like to see your appeal 'tho I'm not an ADR candidate.

Best...