United Brachial Plexus Network, Inc.

I can not beleive it I got 2 letters from AETNA our insurance co dening payment after there medical director okayed frankies surgeries. So I call the medical directors office they said they don't know why I am getting these letters it was approved. Then they called back to say yes they gave the approval so I could have the surgery for frankie but its not up to them if it gets paid. I have to file an appeal with the claims dept. I don't understand how they can do this like I have the time to write letters and file appeals. I have too much to do with caring for frankie and working a full time job to play these games. I can't beleive this is even legal and why wasn't I told this before the surgery. oh no then they were saying it was covered 100% and now the people in the dept that approve these things are saying there is nothing they can do to help me that they have nothing to do with that dept I want to scream and cry at the same time . Just venting Mare

I had the same thing happen to us after Mod Quad. They approved me on September 20th and he had surgery on September 27th. I recieved the letter the day he had surgery. They were trying to tell me that they sent the letter before the surgery so we would have to cover it.....anyways....I just gave it to my attorney(BRANDON's) and she handled it. They ended up paying for it. They had no choice. I had the approval number and everything !!!! Good Luck GAYLE

Mare,
Take your letters of approval AND approval Number to a Lawyer. Let them handle it beyond what you must do in writing a appeal letter & signing permission forms & stuff. SAVE YOURSELF for taking care of YOU and Frankie. The money sacrifice for a lawyer will be worth it.

Hugs and Prayers,
Carolyn J

I don't know about other insurance plans, but when we get an "approval" letter it is just saying they agree the procedure is medically necessary, but it says on it they are not guaranteeing the claim will be paid. All our letters mean is they can't deny claims based on medical necessity. They can (and probably will) try to find other reasons to avoid paying.

Kate

The Dr's office has confirmed that they have a letter from Atena with an agreement for payment but I still for some reason must now file an appeal. At this point I just want to tell everyone to battle it out for themselves I never spoke to my insurance co about any of this the Dr's office handled everything I have no proof of anything that was said or done they just called and said they got the approvals and worked out the payment for 100% I don't know what they expect me to put in an appeals letter. I'd love to hire an attoney but can't afford one Mare

Most insurance companies have caseworkers whom you can get assigned to your case who will help you with these things, it could just be that their paperwork is everywhere and hasn't resolved itself. You could try calling them and asking (perhaps aggressively) that they assign a caseworker to your case who can gather all the correct paperwork and see if there is a real problem or if it's just a matter of getting the right forms to the right person in the right department. If you already have a caseworker, and he/she hasn't done this, or isn't helping, talk to his/her manager. It might take some time on the phone but if it works out then you're spared the cost of a lawyer.

I had the same letters ect stating they would pay Dustin's care at Mayo. After fighting with the insurance co for nearly a year, I sent copies of the letters, a complaint with dates and names of the numerous people I had talked with at the insurance co., brief statements of what they said, ect to the insurance commissioner. These are things I typically note when talking with large companies. The insurance co paid as they stated within 2 weeks of receiving the copy of the complaint from the insurance commissioner. This cost nothing other than the time to fill it out and send it. Complaint form is available on the web. My next step would have been to hire a lawyer but since this worked out I am satisfied. Good luck!! Last thing I needed was the headache of fighting for what they said they would pay.
Sue

My insurance co finally agreed to pay then I got a letter from the hospital saying that part of the bill wasn't paid I called the insurance co they said the hospital has 14 business days to submit there claim then they give up the right to be paid its in there contract but they can't come after me for payment they have to file an appeal with the insurance co to try to get paid it seems like a big rip off the hospital treated my son and should get there money I guess its not just us that insurance co are ripping off Mare