General Category > Insurance

HMO APPEAL

(1/3) > >>

jimmy r:
I am scheduled for surgery at House on 4/10 and leaving maine fior LA on 4/7. I learned at 5pm on Friday, 3/30 that Aetna, my HMO was refusing coverage for HEI after telling my primary care and house that I was covered. HEI is in the CA Aetna HMO but at the 11th hour they are saying that i must see a doctor in my network, specifically Dennis Poe or Samuil Merchant in Boston. I believe that the Boston surgeons are excellent surgeons but i have been advised by several neurosurgeons that it is imperative that I have a recurent surgery performed by someone who has experience with recurences, specifically Dr Brackmann. ( 3 cm removed by Dr House in 1987, now 2.8 cm). I have filed an emergency appeal. I was assured by an ENT surgeon that I will prevail but what a pain. I have made all my plans and am mentally ready to revove the tumor. It appears from other posts that others have prevailed as well.  Of course no one will return my phone calls from Aetna so I have so sweat it out.

krbonner:
Well, phooey on them!  I don't have personal experience, but know many others who have prevailed in such situations.  Keep on them - as you know, you are your own best advocate!

Good luck!
Katie

Sheryl:
Jimmy R - Good luck - I hate insurance companies although I've been very lucky with my BC-BS old fashioned indemnity plan but I do pay dearly for it!!  My advice - keep at them and definitely keep a log of all conversations - dates, person you spoke to, etc.  Also, keep copies of paperwork. 
Keep us posted - BOO to the HMO's.
Sheryl

jimmy r:
I lost my first appeal. I will see the Doctors that they have approved (Dr Mekena at Mass Eye and ear, and Dr Dennis Poe). I will see what their experience is and then decide if I will file a second appeal.

krbonner:
I'm truly sorry you lost the appeal.  You really should be able to see who you want, regardless of geography.

That said, you'd be in great hands with McKenna.  See my post in your other thread...

Katie

Navigation

[0] Message Index

[#] Next page