Thank you all for tolerating my tantrum. To explain my situation: I had to switch to an ACA HMO at the start of the year. I found a wonderful GP who was a great addition to my care team, as she was familiar with most of my oncology team. However, the rectal surgeon (who is in network), used the referral from last year so Aetna denied claim because there was no pre-authorization. Then they said I had needed to request continuity care for ALL medical care associated with the cancer so they denied all oncology follow-ups. Now they said they will not cover my colonoscopy because I had one last year (when the cancer was diagnosed) so I am not eligible for another for five years. @dlydailyhope
It is standard medical practice to have a one year follow-up colonoscopy after diagnosis of colon cancer and treatment. Moreover, after the one year follow-up colonoscopy, it is usually recommended to have the next colonoscopy in three years--not five. It seems that Aetna is relying on the paperwork trail to deny coverage. This is not something a colon cancer survivor should have to be dealing with. Hopefully, this site can provide you with resources to address the probable illegality of this situation.
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It is standard medical practice to have a one year follow-up colonoscopy after diagnosis of colon cancer and treatment. Moreover, after the one year follow-up colonoscopy, it is usually recommended to have the next colonoscopy in three years--not five. It seems that Aetna is relying on the paperwork trail to deny coverage. This is not something a colon cancer survivor should have to be dealing with. Hopefully, this site can provide you with resources to address the probable illegality of this situation.
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