Re: AETNA - NEED ADVICE ASAP

[Guest guest]

A few tips:

Your speech eval is day 1....you'll have 59 days to complete the treatment.

THATS IT. LIFETIME. OT is the same.

Suggestion is to find a facility or therapist that can schedule you at least 4

times a week during those two months, so your child gets the most out of the

therapy they can. Your plan sounds exactly like ours. I hope you never need MH

services.

`k

Kim wrote:

Hi all,

I have been reading many posts in reference to AETNA and I am really

concerned. My company just switched to AETNA June 1, 2004 and I have not

submitted

any claims as of yet. I was told that they will cover 60 consecutive days

" per

condition " . My co-pay is $20.00 per visit.

Any successes out there??? What codes did you use when submitting that were

successful in receiving payment?????

Any help would be greatly appreciated

You can email me privately if you like at sedona508@...

Thanks again!!!!

Kim (Mom of Connor 5 severe verbal apraxia)

New Jersey

[Guest guest]

Kim

We used Aetna and they paid for my sons speech therapy for once a week for a

year. If you have the proper medical diagnoses in place, it should be

covered. THey initially denied it until we sent the eval to them and then they

covered it.

Good luck

[Guest guest]

Yes, my key to getting this stuff covered is to call the insurance

company and get a CS rep and say, " The XXXXX therapy has been denied

and that's not acceptable. What do you need in order to get it

covered? " The response is usually to get a letter of medical

necessity from our Ped or a Dev Ped. Thus far, it's worked, though

you cannot deny (in my book) that a child who is 4 and unable to

speak needs therapy, some peds won't go out on a limb like that, and

others may disagree. Finally, this may not work with all ins. cos.

We are very lucky to have great insurance coverage through my

husband's position with a huge company - so huge that they have HR

people in place to handle problems with the med insurance. After

contacting them a couple of times, I think the ins co now just red

flags us and gives me what I want. Squeaky wheel and all that. Good

luck! And don't give up!!

Marina

> Kim

> We used Aetna and they paid for my sons speech therapy for once a

week for a

> year. If you have the proper medical diagnoses in place, it should

be

> covered. THey initially denied it until we sent the eval to them

and then they

> covered it.

>

> Good luck

>

>

>

>

>

>

[Guest guest]

That sounds just like how we got Aetna to cover us. Be sure to keep

all of those records because Aetna has " lost " all of our

information, and I've had to fax them all of my copies.

> HI,

> I have AETNA PPO. I had to go through our Human Resource Dept.

and talked to

> the lady head of the medical records. (Mind you I fought with

AETNA for one

> year, full of tears) then I submitted 2 files stacked about 10

inches high on

> my boys records to that lady in my HR dept. She then contacted

Aetna and

> re-negotiated the Aetna Contract with our organization, and now we

are covered.

> Good LUCK!!

>

>

>