Re: How long before Aetna makes determination?

[Guest guest]

aetna covered our doc band without any problems.

Aron Holwighttp://birds.lemonyfresh.com/gallery/http://b1.lilypie.com/2QXlm7.png

On 10/18/06, Carmen <cutiecee@...> wrote:

Well the braniacs at Hanger filed claims with Aetna for my twins helmets last week (after telling us they had done so back in August). Well I noticed today that the claim was in their (Aetna)system saying " Additional info required. " So I emailed them and this is what they had to say:This claim was received on October 13, 2006. It normally takes 10-15business days for claims to be finalized. However, because of the typeof durable medical equipment this is, it will take longer to determine if it is a coverable expense for your plan. Equipment like this shouldbe precertified prior to purchasing to determine if the equipment iscovered.I was never told it had to get anything pre-certified. All I know was that the woman from Hanger called Aetna and they simply told her that it was considered cosmetic and would not be covered.When I called Aetna a couple of weeks ago, they told me that helmets WOULD be covered as long as we had all documentation and that twins met criteria with measurements (which they do).So I guess I'll just have to sit back and hope for the best. Any experiences with Aetna? Did they cover your helmets?Carmen

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[Guest guest]

Hi Carmen,

It's interesting you should mention this because I was just talking to the claims person for Cranial Tech the other day about this. We were told by CT that AETNA requires pre-certification. So I went and got all they required and then some. CT submitted it ... we were told that we had to get the pre-cert before she was even casted, otherwise AETNA might deny part or all of it because they don't like it when you don't follow their steps.. and pre-cert needs to be completed before anything is done. So we waited two weeks. The pre-cert came through and we were approved. We got her casted and banded. She's been in it for almost two months now. And guess what... the claim was submitted in the end of August and AETNA has not paid it yet (but they are paying out other medical claims, doctor's visits, etc with lightening speed). CT keeps sending us bills.

So I called CT's claims person and spoke with her. She said that for some reason, she thinks there has been some major restructuring within AETNA and their customers service, it is taking them FIVE MONTHS to pay out cranial helmet claims right now. I asked her if I should be worried since all our other medical claims are getting paid within a day or two of receipt and that AETNA is not even showing her DOCband claim as being received yet). She said since we received approval via pre-certification and went through the proper channels she said no (although pre-cert is not a guarantee that they will pay). She said that they are only being slow now with the cranial helmet claims. She also had checked and AETNA does HAVE our claim, they just haven't put it in the system for some reason for me to see yet). She said she has had some claims be denied by AETNA because they did not get the pre-cert or went ahead with the casting and helmet at the same time as getting a pre-cert (even though the pre-cert went through). However she has not had a single claim denied yet that got the pre-cert before starting the casting and helmet process.

So we are still waiting for AETNA to pay and crossing their fingers that they don't pull anything on us. We receive different stories any time we talk to AETNA about any issue= half their reps don't know what they're talking about and can't read our policy correctly. So I tend to not value anything a customer rep says. The CT claims person said the same thing, she gets the proper help about 50% of the time and the rest it's someone giving her the wrong info. Very frustrating.

So my advice would be to ready to hurry up and wait.. and wait some more. I would also keep on their case and keep calling- weekly LOL. I don't know if it would work, but I would try and get Hanger to contact them and notify them that through THEIR error, they erroneously told you false info about getting a pre-cert. Hopefully that will help your case with AETNA a bit.

I really hope it works out for you... please let us know what happens!

Best wishes,

Colleen

How long before Aetna makes determination?

Well the braniacs at Hanger filed claims with Aetna for my twins helmets last week (after telling us they had done so back in August). Well I noticed today that the claim was in their (Aetna)system saying "Additional info required." So I emailed them and this is what they had to say:This claim was received on October 13, 2006. It normally takes 10-15business days for claims to be finalized. However, because of the typeof durable medical equipment this is, it will take longer to determine if it is a coverable expense for your plan. Equipment like this shouldbe precertified prior to purchasing to determine if the equipment iscovered.I was never told it had to get anything pre-certified. All I know was that the woman from Hanger called Aetna and they simply told her that it was considered cosmetic and would not be covered.When I called Aetna a couple of weeks ago, they told me that helmets WOULD be covered as long as we had all documentation and that twins met criteria with measurements (which they do).So I guess I'll just have to sit back and hope for the best. Any experiences with Aetna? Did they cover your helmets?Carmen