Health Insurance Denial Compounds Grief

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I am pursuing appeals against aetna for denial of a medically necessary procedure (arthroscopy of the hip).
In answering the above question, it sounds like this person (b. rogers) needs to go through the member appeal-grievance appeal and make a strong statement that there was no way this was a work-related injury.
See what evidence/proof they provide-- and then keep appealing until you reach
the highest level. It sounds like a mistake made by the insurer.
In my case, it is a bad policy decision which must be overturned, not so much a mistake but a routine denial of an uncovered benefit, without any provision of alternative treatment.
Appeals can be won with persistence -- and thinking "outside the box" as to how to present one's case.

Ellen Trumpler of CA 3:16AM April 27, 2010

Insurance denial always come with reason and we can sort it out by call them and giving more information.
http://www.whatismedicalinsurancebilling.org/

Puru of FL 6:49AM April 07, 2010

My mother is in the same situation at this point with Aetna denying transportation to her hometown. She needs to be transferred to a facility there for further care. Aetna is denying transportation to her hometown and they will not fly her or transport her to her hometown. Only to a nearest facility in Houston in which is not her hometown. She is still on a ventilator and feeding tube. We are appealing and she is still at Houston Methodist Hospital. THe case worker has not made it any better for us either. She is rude and heartless about the situation. So sad that we have people working in the medical field and have no heart. We are praying about the situation and hoping we will win this appeal. If Aetna was smart they should transfer my mom instead wasting money at the most expensive hospital in Houston. Its eating up Aetna medcial money. So sad:(

Rachel of TX 11:42AM November 19, 2009

Recently had ruptured spleen. The insurance company denied coverage of medical bills stating it was a work related injury.
I am not sure what caused it. What type of evidence/proof must they furnish me upon appeal?

bryan rogers of TX 1:33PM August 19, 2008

I would like for you to forward this article to my son who is in a similar prdiciment where the insurance i denying his claim because they say it is work related. Several weks ago he was diagnosed with a ruptured spleen and could not recall what may have caused it.
Please reply and forward to him at
beer4war@sbcglobal.net

Bill Rogers of AR 1:30PM August 19, 2008

I have the evidence and have sued my HMO. The type of behavior I describe in my blog, Tuesdays Tirades and Tales (tuesdaytiradesandtales.blogspot.com), does not happen in a vacuum, as you know. After three years of investigating my health insurance company, Carelink Health Plans Inc. of West Virginia and its parent company, Coventry Health Care of Bethesda MD., I have discovered much abusive behavior and write an account of a bizarre journey. Just consider the significance of my findings: it matters not in many cases if one is insured. Health plans routinely deny "rightful" benefits to the insured. Let's join hands!

Penny Stenger of WV 4:05PM July 22, 2008

Consumers need to consider options that may or may not be feasible under current law. In my opinion, it might be time for some real lawsuits perhaps based on denial of access based on disability...Title VII. While not currently used in this context, discrimination against the disabled sick that deprives them of needed medical care based solely on their disability (inability to transport themselves or safely be transported by other current means of transportation) is a socially irresponsible action that amounts to discrimination against our disabled.
Medicare Part B provides for coverage of such services but uses their ABN (advance beneficiary notices) and physician certification requirements (get a doctor's note). Not hopeless without either as many people are bedridden which also warrants ambulance usage and which is an arguable issue as to fact.
This kind of coverage should be a mandated part of all health insurance policies but is not. The biggest challenge is that people who are well cannot effectively empathize with what goes on in today's environment with those who are ill. By denying transportation many people are denied medical care based on their disability of illness. Get the care you need and pursue the issue with governmental and insurance entities.
It would be great to start seeing claims for mental distress brought against insurance companies because of their actions based on actual damages caused by unjustified denials and delays in payment where mental harm could have and should have been anticipated.

conoutofconsumer of NC 9:24AM April 06, 2008