Guest guest Posted October 27, 2004 Report Share Posted October 27, 2004 I have Aetna (HMO) in California, and they approved me on the first go-around as medically necessary (minus the genioplasty, which they have an exclusion for as *always* being considered cosmetic). My surgeon said he wrote an extremely persuasive letter, which is what I'm assuming did the trick -- his office manager (and my ortho) said they were both pleasantly surprised that we didn't have to even go with an appeal. (Knock on wood -- it's still nearly 2 months to my surgery date so I don't want to jinx it!) > > anyone have Aetna? have any success with them? I'm in a renewal > period with my employer and this is an insurance provider that i > could go with. my current plan (not aetna) has a specific exclusion > for orthognathic surgery. it was excluded per my employer on this > plan, so I am looking to change plans and Aetna said that as long as > its medically necessary, they'll cover it. Its a POS plan by the > way... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2004 Report Share Posted October 27, 2004 I have Aetna (HMO) in California, and they approved me on the first go-around as medically necessary (minus the genioplasty, which they have an exclusion for as *always* being considered cosmetic). My surgeon said he wrote an extremely persuasive letter, which is what I'm assuming did the trick -- his office manager (and my ortho) said they were both pleasantly surprised that we didn't have to even go with an appeal. (Knock on wood -- it's still nearly 2 months to my surgery date so I don't want to jinx it!) > > anyone have Aetna? have any success with them? I'm in a renewal > period with my employer and this is an insurance provider that i > could go with. my current plan (not aetna) has a specific exclusion > for orthognathic surgery. it was excluded per my employer on this > plan, so I am looking to change plans and Aetna said that as long as > its medically necessary, they'll cover it. Its a POS plan by the > way... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2004 Report Share Posted October 27, 2004 thanks for the reply. this board and its members are extremely helpful and a huge blessing to those out there, like me, seeing info. good luck with the surgery in the next couple months. > > > > anyone have Aetna? have any success with them? I'm in a renewal > > period with my employer and this is an insurance provider that i > > could go with. my current plan (not aetna) has a specific > exclusion > > for orthognathic surgery. it was excluded per my employer on this > > plan, so I am looking to change plans and Aetna said that as long > as > > its medically necessary, they'll cover it. Its a POS plan by the > > way... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2004 Report Share Posted October 27, 2004 thanks for the reply. this board and its members are extremely helpful and a huge blessing to those out there, like me, seeing info. good luck with the surgery in the next couple months. > > > > anyone have Aetna? have any success with them? I'm in a renewal > > period with my employer and this is an insurance provider that i > > could go with. my current plan (not aetna) has a specific > exclusion > > for orthognathic surgery. it was excluded per my employer on this > > plan, so I am looking to change plans and Aetna said that as long > as > > its medically necessary, they'll cover it. Its a POS plan by the > > way... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2004 Report Share Posted October 27, 2004 I have had the great fortune of being approved through my Aetna PPO, though this surgery is not automatically covered. My doctor wrote a very thorough letter (and gave me a copy)and sent plenty of proof (paperwork, xrays, ect) to prove that this is NOT a cosmetic procedure. A few months after that, I received a letter from Aetna telling me that I was approved and how much they will cover. Just be aware of a few things: 1. If at first you don't succeed, try try again, because what often happens is that when you send in your request again, a different person/group will review your case. 2. If you are approved, please read carefully what you were approved for and for how much, and how much you will be left to pay for. Hopefully when you are approved, they will cover at a 24 hour hospital stay. 3. If after some tries you are still denied, you can take a more assertive approach. I think (Fiddlesticks on this site) may have some info on that, if I remember correctly. Good Luck! Bea > > anyone have Aetna? have any success with them? I'm in a renewal > period with my employer and this is an insurance provider that i > could go with. my current plan (not aetna) has a specific exclusion > for orthognathic surgery. it was excluded per my employer on this > plan, so I am looking to change plans and Aetna said that as long as > its medically necessary, they'll cover it. Its a POS plan by the > way... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2004 Report Share Posted October 27, 2004 I have had the great fortune of being approved through my Aetna PPO, though this surgery is not automatically covered. My doctor wrote a very thorough letter (and gave me a copy)and sent plenty of proof (paperwork, xrays, ect) to prove that this is NOT a cosmetic procedure. A few months after that, I received a letter from Aetna telling me that I was approved and how much they will cover. Just be aware of a few things: 1. If at first you don't succeed, try try again, because what often happens is that when you send in your request again, a different person/group will review your case. 2. If you are approved, please read carefully what you were approved for and for how much, and how much you will be left to pay for. Hopefully when you are approved, they will cover at a 24 hour hospital stay. 3. If after some tries you are still denied, you can take a more assertive approach. I think (Fiddlesticks on this site) may have some info on that, if I remember correctly. Good Luck! Bea > > anyone have Aetna? have any success with them? I'm in a renewal > period with my employer and this is an insurance provider that i > could go with. my current plan (not aetna) has a specific exclusion > for orthognathic surgery. it was excluded per my employer on this > plan, so I am looking to change plans and Aetna said that as long as > its medically necessary, they'll cover it. Its a POS plan by the > way... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2004 Report Share Posted October 28, 2004 Hi Bea, Actually, I'm the worst person to ask about insurance as in Ontario Canada, where I had my surgery, everything was covered by our provincial health insurance plan. I only had to pay for the visits to my surgeon out-of-hospital (and of course, my ortho treatment). I can only imagine the frustrations others have to go through in getting this surgery approved. > > I have had the great fortune of being approved through my Aetna PPO, > though this surgery is not automatically covered. My doctor wrote a > very thorough letter (and gave me a copy)and sent plenty of proof > (paperwork, xrays, ect) to prove that this is NOT a cosmetic > procedure. A few months after that, I received a letter from Aetna > telling me that I was approved and how much they will cover. > Just be aware of a few things: 1. If at first you don't succeed, try > try again, because what often happens is that when you send in your > request again, a different person/group will review your case. 2. > If you are approved, please read carefully what you were approved for > and for how much, and how much you will be left to pay for. Hopefully > when you are approved, they will cover at a 24 hour hospital stay. > 3. If after some tries you are still denied, you can take a more > assertive approach. I think (Fiddlesticks on this site) may > have some info on that, if I remember correctly. > > Good Luck! > > Bea Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2004 Report Share Posted October 28, 2004 Hi Bea, Actually, I'm the worst person to ask about insurance as in Ontario Canada, where I had my surgery, everything was covered by our provincial health insurance plan. I only had to pay for the visits to my surgeon out-of-hospital (and of course, my ortho treatment). I can only imagine the frustrations others have to go through in getting this surgery approved. > > I have had the great fortune of being approved through my Aetna PPO, > though this surgery is not automatically covered. My doctor wrote a > very thorough letter (and gave me a copy)and sent plenty of proof > (paperwork, xrays, ect) to prove that this is NOT a cosmetic > procedure. A few months after that, I received a letter from Aetna > telling me that I was approved and how much they will cover. > Just be aware of a few things: 1. If at first you don't succeed, try > try again, because what often happens is that when you send in your > request again, a different person/group will review your case. 2. > If you are approved, please read carefully what you were approved for > and for how much, and how much you will be left to pay for. Hopefully > when you are approved, they will cover at a 24 hour hospital stay. > 3. If after some tries you are still denied, you can take a more > assertive approach. I think (Fiddlesticks on this site) may > have some info on that, if I remember correctly. > > Good Luck! > > Bea Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2004 Report Share Posted October 28, 2004 Oh, shoot, I could have sworn it was your website that had info on insurance and even a copy of a letter to send the insurance companies...I will have to look where I got that info! B > > > > I have had the great fortune of being approved through my Aetna > PPO, > > though this surgery is not automatically covered. My doctor wrote a > > very thorough letter (and gave me a copy)and sent plenty of proof > > (paperwork, xrays, ect) to prove that this is NOT a cosmetic > > procedure. A few months after that, I received a letter from Aetna > > telling me that I was approved and how much they will cover. > > Just be aware of a few things: 1. If at first you don't succeed, > try > > try again, because what often happens is that when you send in your > > request again, a different person/group will review your case. 2. > > If you are approved, please read carefully what you were approved > for > > and for how much, and how much you will be left to pay for. > Hopefully > > when you are approved, they will cover at a 24 hour hospital stay. > > 3. If after some tries you are still denied, you can take a more > > assertive approach. I think (Fiddlesticks on this site) may > > have some info on that, if I remember correctly. > > > > Good Luck! > > > > Bea Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2004 Report Share Posted October 28, 2004 Oh, shoot, I could have sworn it was your website that had info on insurance and even a copy of a letter to send the insurance companies...I will have to look where I got that info! B > > > > I have had the great fortune of being approved through my Aetna > PPO, > > though this surgery is not automatically covered. My doctor wrote a > > very thorough letter (and gave me a copy)and sent plenty of proof > > (paperwork, xrays, ect) to prove that this is NOT a cosmetic > > procedure. A few months after that, I received a letter from Aetna > > telling me that I was approved and how much they will cover. > > Just be aware of a few things: 1. If at first you don't succeed, > try > > try again, because what often happens is that when you send in your > > request again, a different person/group will review your case. 2. > > If you are approved, please read carefully what you were approved > for > > and for how much, and how much you will be left to pay for. > Hopefully > > when you are approved, they will cover at a 24 hour hospital stay. > > 3. If after some tries you are still denied, you can take a more > > assertive approach. I think (Fiddlesticks on this site) may > > have some info on that, if I remember correctly. > > > > Good Luck! > > > > Bea Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2004 Report Share Posted October 29, 2004 It is 's Geocities site -- look in the links. It's just that she herself didn't have to go through a company. Cammie > > > > > > I have had the great fortune of being approved through my Aetna > > PPO, > > > though this surgery is not automatically covered. My doctor wrote > a > > > very thorough letter (and gave me a copy)and sent plenty of proof > > > (paperwork, xrays, ect) to prove that this is NOT a cosmetic > > > procedure. A few months after that, I received a letter from > Aetna > > > telling me that I was approved and how much they will cover. > > > Just be aware of a few things: 1. If at first you don't succeed, > > try > > > try again, because what often happens is that when you send in > your > > > request again, a different person/group will review your case. > 2. > > > If you are approved, please read carefully what you were approved > > for > > > and for how much, and how much you will be left to pay for. > > Hopefully > > > when you are approved, they will cover at a 24 hour hospital > stay. > > > 3. If after some tries you are still denied, you can take a more > > > assertive approach. I think (Fiddlesticks on this site) may > > > have some info on that, if I remember correctly. > > > > > > Good Luck! > > > > > > Bea Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2004 Report Share Posted October 29, 2004 It is 's Geocities site -- look in the links. It's just that she herself didn't have to go through a company. Cammie > > > > > > I have had the great fortune of being approved through my Aetna > > PPO, > > > though this surgery is not automatically covered. My doctor wrote > a > > > very thorough letter (and gave me a copy)and sent plenty of proof > > > (paperwork, xrays, ect) to prove that this is NOT a cosmetic > > > procedure. A few months after that, I received a letter from > Aetna > > > telling me that I was approved and how much they will cover. > > > Just be aware of a few things: 1. If at first you don't succeed, > > try > > > try again, because what often happens is that when you send in > your > > > request again, a different person/group will review your case. > 2. > > > If you are approved, please read carefully what you were approved > > for > > > and for how much, and how much you will be left to pay for. > > Hopefully > > > when you are approved, they will cover at a 24 hour hospital > stay. > > > 3. If after some tries you are still denied, you can take a more > > > assertive approach. I think (Fiddlesticks on this site) may > > > have some info on that, if I remember correctly. > > > > > > Good Luck! > > > > > > Bea Quote Link to comment Share on other sites More sharing options...
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