Insurance Question

[Guest guest]

Hi Susie,

We struggle a lot with getting our medical insurance (Aetna) to pay for the

much needed therapy for our son. We end up appealing at least 4 times each

year. They always reverse their decision after our continue fight. We have

asked how can we make this process easier and no one ever has an answer.

They won't give us a case manager. We tried submitting preapproval for the

year or for a number of visits, they come back and say you don't need

preapproval for therapy. This last appeal we submitted was for PT & OT for

the last 4 months of last year - the first appeal for this time frame, when

I called to get the decision I was told it was the 3rd appeal and would have

to go to my husbands company. Which isn't true, it was the 1st appeal,

after much discussion they agreed and now is in the first appeal process but

have to wait yet another 30 days for a decision. It just seems like they

will do anything not to have to pay. It doesn't matter the time I have to

spend fighting to get services paid and that all this takes hours away from

son. Not to mention that our provider has to wait for 7-9 months before

getting paid.

We have also contact the IL department of Insurance and after doing so Aetna

also considered it an appeal. The department of Insurance was unable to

help since my husband's company (Tyco) is self insured.

So my question is do you have any suggestions on how we can get Aetna to pay

when they are supposed to?

We would appreciate any advice you could give.

Thank you for your help.

Kathy