Re: Another insurance question--Aetna

[Guest guest]

Hi Molly,

Your OS's office would be the best ones to help you with the appeal.

Many insurance companies refuse to treat TMJ problems or cover very

little (i.e. $500 lifetime limit) so I'm not surprised that they

denied you the first time around. Have your surgeon's office help

you draft a letter to appeal their decision. You may have to appeal

several times even before they approve the surgery.

I was lucky in that my insurance approved my orthognathic and TMJ

surgeries without any appeals. They have been reluctant to pay for

subsequent physical therapy. I'm still fighting that.

Good luck and be persistant with the insurance.

> Hi all,

>

> My OS submitted paperwork to Aetna a few weeks ago stating that I

> need a meniscectomy, arthroplasty, and split to repair my right

TMJ

> disk displacement. Aetna denied the claim " for incomplete non-

> surgical management " reasons. I need to appeal this! Has anyone

on

> this list run into the same problem? I'm from Massachusetts, and

> have already combed through the Statutes trying to find info on

> health insurance coverage for jaw surgery, but to no avail.

>

> Also, I'm supposed to wait 3 months after the above joint

procedures

> before undergoing upper and lower surgery. I'm pretty panicked as

I

> basically have from June-August when I don't have to deal with the

> public at work, so I'd like to get the upper-lower surgery in June.

>

> Thanks!

> Molly

[Guest guest]

Sorry, but I don't know what some of those things are.

Best general suggestion I can offer is to talk with your surgeon, see

if he has an insurance person in his office, and ask for help.

Usually there's somebody there who knows his/her way through the

insurance thicket.

Good wishes to you. And try not to let yourself get panicked. After

all, and I do understand your having a preference about the " whens, "

this stuff will or won't happen when it can, and you'll deal with the

outcome. Honestly. Most people are very sympathetic and helpful, once

they understand a bit about what's going on.

Cammie

> Hi all,

>

> My OS submitted paperwork to Aetna a few weeks ago stating that I

> need a meniscectomy, arthroplasty, and split to repair my right TMJ

> disk displacement. Aetna denied the claim " for incomplete non-

> surgical management " reasons. I need to appeal this! Has anyone

on

> this list run into the same problem? I'm from Massachusetts, and

> have already combed through the Statutes trying to find info on

> health insurance coverage for jaw surgery, but to no avail.

>

> Also, I'm supposed to wait 3 months after the above joint

procedures

> before undergoing upper and lower surgery. I'm pretty panicked as

I

> basically have from June-August when I don't have to deal with the

> public at work, so I'd like to get the upper-lower surgery in June.

>

> Thanks!

> Molly