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@hopenjoy2024
Did your surgeon’s office not get preauthorization for your surgery and post surgery care? That is what they should do. Members/patients should not have to push this process when the provider needs to provide clinical information to Aetna for preauthorization approval. They should not have done the surgery until everything was buttoned up. I would ask that practice manager for help getting post surgery appeal approval of all medical claims for surgery and post surgery oncology. You may need an attorney to help you and you can check your state for help with your insurance claims. You should not be penalized during a scary time when you were relying on your providers for care.
I am fighting the same problem where Aetna is denying coverage of surgery and needs the surgeon to do a provider appeal. I met with him 6 weeks ago and my surgery is Monday. Why the surgeon’s preauthorization team dropped the ball, I don’t know. Very frustrating.
Replies to "@hopenjoy2024 Did your surgeon’s office not get preauthorization for your surgery and post surgery care? That..."
Yes, it was an anoscopy in office, 6 month check up. The surgeon’s office pre-auth-ed with the new insurance but submitted the claim using a referral from the oncologist, not the GP which is not allowed. When the claim was denied, they sent me a bill, which I paid on the assumption it was copays and coinsurance since it was a new year and out of pocket maximums did not apply. If I would have contacted the doctor’s office when I received the bill, they would have been able to appeal and resubmit.
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@dlydailyhope
Just cannot understand how you can get this sorted before Monday and if not, they will likely charge you fora no-show if you cancel now- not to mention a re-schedule wait.
And I am now stuck in process of waiting patiently for the appeal process to play out.