I need some help with an appeal

[Guest guest]

I received some very unfortunate news today. I switched to Aetna last fall and

turned in my Xolair application after being covered by Humana the previous year.

Aetna declined the application at that time because I didn't meet all of the

criteria but Aetna's Specialty Pharmacy told me I had been approved and they've

been sending me the shot for the past 9 or so months. Aetna has not paid them a

cent. I guess Aetna and Aetna Specialty Pharmacy are two different divisions

who apparently don't communicate very well.

Long story short....the denial is still in effect and I'm cut off from the

shot so I have to begin the appeals process. I was going to contact Spoc Online

but I was wondering if anyone can shed some light on the process since a number

of you have already been through this before.

Thanks,

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