Guest guest Posted August 1, 2001 Report Share Posted August 1, 2001 Sonomi, Can you send me a copy of your Summary Plan Description from Aetna? Your surgery should be covered by a new carrier, since it was already approved by prior insurance carrier. However, I need to see a copy of the booklet to determine what is stated in several different parts of the booklet, plus approximate number of employees in the company your husband works for. Most sincerely, Martha Murdock NSIF ----- Original Message ----- From: johnson sonomi MAM-NSIF@... Sent: Tuesday, July 31, 2001 11:11 PM Hi Martha.I heard from Patty about you.You knows a lot about insurance.and thank you for mail to me.my insurance company is Aetna insurance.My husband is working AL-SALAM Saudi arabia) and the company used have General America insurance until end of JUN.We contact with then the general america said they cover my remove implant surgery.This is the General America insurance mail to me.With regard to coverage for the removal of breast implants: Your medicalinsurance plan covers the removal of breast implants. If, after theimplants are removed, the patient wants or needs to have reconstructivebreast surgery, the plan will not cover the reconstructive surgery.The plan covers for the removal of the breast implants. It does not coverfor reconstructive surgery following the removal of the implants.With regard to precertification: There is no specified requirement that thepatient must see/his her doctor in order for the precertification to bedone. However, it is generally the case that a patient will consult his/herdoctor prior to undergoing a surgical procedure. Most commonly, ourexperience is that a patient goes to the doctor for a consultation as tothe necessity of surgery. If surgery is decided upon, then the doctor'soffice contacts GenAm for the precertification. In order for aprecertification to be accomplished, it is necessary that we know theproposed type of surgery, the medical diagnosis necessitating the surgery,whether is will be performed on an inpatient or outpatient basis, and theapproximate date that the doctor expects to perform the surgery. Thesespecifics are usually not able to be determined without a visit by thepatient to the doctor's office.Should you pay any portion of expenses from your own pocket, this will nothave any effect on the benefits payable under your insurance plan. Pleasebe advised that your insurance plan is a Preferred Provider Plan. Thismeans that if the doctor, hospital, or other provider of service is amember of the preferred provider organization, there can be discounts onthe provider's charges, based on the contracted rates of the preferredprovider organization. If you pay at the time of service and the provideris in the preferrred provider organization and discounts apply, you maythen have overpaid the claim. This should be considered before making anypayments to providers. Providers participating in the preferred providerorganization are not supposed to bill patients up front, in the event thatdiscounts do apply.The preferred provider organzation for this plan isPrivate Healthcare Systems. and the General America insurance aprroved my surgery.i had Schedule of surgery in July 24.But we found out they change insurance to Aetna right before my surgery, started july."Continuation of Benefits" this is we are trying to right now.I just send my medical record to Dr.we are waiting from insurance.I change my surgery date to SEP.hope they approved.I'll write to you what insurance said soon.When i hear from insurance.if they don't aprroved i need ask your help.Thak you.Sonomi_________________________________________________________________$BL5NA%a!<%k$O!"@$3 & (B No.1 $B$N(B MSN Hotmail $B$G!*(Bhttp://www.hotmail.com/JA/ Quote Link to comment Share on other sites More sharing options...
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