Hello to all,
I don't know if this goes here or not. I have just about had it with Aetna insurance company. This past Saturday, they sent me an appeal letter for the VNS charges from 2007. They have paid half. I am not even responding to this. The letter states they got this appeal on Jan. 14. IT doesn't say from whom. I think they are bluffing. Because I have nothing to appeal, as my awards letter states they are to pay these VNS charges!!! I am not starting another paper war, as they are supposed to pay these charges! I have already called everyone again, to tell them about this bull.
Has anyone experienced this?! Aetna is acting like I am supposed to pay! I am just getting so upset. Why do they keep doing this?! The awards letter is binding and legal. They are acting like it doesn't even exist!!! In addition, I met my deductible last year, paid my 20%, and according to that, Aetna is supposed to pay at 100% after that anyway! So, they should pay anything after that at 100%.
I called my husbands employer, and asked if I should get a lawyer, call the head office and or the medical director of my husbands employer. I am sick of this and just want this problem to be over!!! And resolved. I am sick of this Bull##**!
Now, I have had trouble sleeping, waking up early etc. I have called my doctor to ask her if I can take Klonopin for awhile so I can sleep at night. As with all this mess, I have been too upset to even get to sleep, and am waking up early. I already took one Klonopin last night, and got a decent nights sleep. But, I am VERY upset with this new crap Aetna has thrown at me.
If anyone has experienced this with their insurance company, please let me know. I think this is just a tactic of theirs; and I am NOT falling for it. AS, I should not have to appeal for anything with the awards letter I have.
Thank you.
Sincerely,
Bonnie :Really Mad:
Bonnie, for the most part, those with VNS for epilepsy have few if any insurance problems. VNS was embraced and accepted as a viable treatement.
But for those with depression it's been another battle. Aetna, BCBS and CMS ALL stated they would not pay for VNS in the treatment of depression. Their statements are located elsewhere on this site.
These companies also stated it would be a case-by-case coverage. If you have a statement of coverage and they are backpeddling now, you may have to seek legal recourse.
Have you contacted your CYBX case manager?
Dear Birdbomb,
Yes, I have contacted my Cyberonics Caseworker, and left her a message. I even asked her if the VNS settings would be covered by the awards letter I have, and she said the letter covered that as part of the treatment. I asked this BEFORE I even had the VNS surgery.
Aetna has the Awards letter, everyone working with me has the Awards letter. Aetna is just choosing to ignore it. I even have a copy of the Awards letter myself. The Awards letter gave me permission for the VNS surgery and treatment in connection with it; in otherwords the settings. It also stated that this VNS treatment is no longer considered experimental. This is in the awards letter I have.
I am ready to go to a lawyer! If my husband's company cannot fix this soon, I guess I will have no other option. I want to talk to my caseworker @ Cyberonics first, and my husbands employer next, before I do that.
I thought this HELL was over; and now another HELL is starting. I am sorry I ever got this! Maybe, I should just go in and get the damned thing turned off forever! I'm tired of this turmoil. I am not calling Aetna; as it does NO GOOD. They don't listen to me anyway.
If my caseworker & husbands employer tell me to get a lawyer; then that is what I will do! But, I want to give my husband's employer a chance to fix it. Since they helped me get the approval for the surgery (with my pressure) in the first place.
Thank you for writing me back.
Sincerely,
Bonnie
One other avenue is the State's Attorney's office, governor, or Insurance Commissioner Office of your state.