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Insurance Denial...Aetna Sucks
Posted on 7/15/20 at 12:08 pm
Posted on 7/15/20 at 12:08 pm
Just spoke to my sister, she is really upset. My 11 year old nephew was diagnosed with Chron's disease this past December when he had a major flare up. Was seen admitted to Children's hospital in Houston area and treated. Has been doing IV treatments since of Rimicade. Their insurance denied charges and of course they appealed, even the doctor's submitted info etc. She just got the final appeal denied. Treatments are something like 30K each. He was supposed to do another treatment this week, but everything is on hold now, but doctor is wanting them to keep going. Anyone had to deal with this type of stuff with insurance company....oh by the way Aetna SUCKS!
This post was edited on 7/15/20 at 12:16 pm
13
Posted on 7/15/20 at 12:09 pm to Shotgun Willie
I haven't had to deal with this.
But what is the reason for the denial of treatment?
But what is the reason for the denial of treatment?
Posted on 7/15/20 at 12:10 pm to Shotgun Willie
Let me guess, pre-existing condition?
Posted on 7/15/20 at 12:10 pm to meansonny
quote:
But what is the reason for the denial of treatment?
From my understanding they said that other treatments should have been done first, but the doctors explained that with the case he had this was the only treatment. He had lost a lot of weight, and has now put most of it back on and was doing well.
Posted on 7/15/20 at 12:11 pm to Shotgun Willie
Man that is terrible. I know this though - if my child’s health is on the line, I’m losing my home in order to keep them healthy if I have to.
Posted on 7/15/20 at 12:11 pm to Shotgun Willie
Sounds like they should have gotten pre-approval. Maybe they didn't know, but the Dr should have.
Posted on 7/15/20 at 12:13 pm to Shotgun Willie
Posted on 7/15/20 at 12:13 pm to Shotgun Willie
You're learning first hand why insurance reform is needed but can't get any traction due to the politics involved by BOTH sides of the aisle and the Big Insurance Lobby.
Don't fall into the trap of believing it's simply Red or Blue. It isn't. That's the design. Big ups to your nephew and hope he stays tough.
Posted on 7/15/20 at 12:14 pm to Shotgun Willie
Yes Aetna does suck. There are patient advocates you can hire to work with Aetna. Sounds like remicade was excluded. They probably have a similar drug that he could have tried first, but that is not your sisters job to figure out. Also that takes a long time and time equals suffering.
Posted on 7/15/20 at 12:18 pm to Shotgun Willie
quote:
Aetna SUCKS!
All private, for-profit insurance companies suck.
Posted on 7/15/20 at 12:19 pm to Shotgun Willie
I have Crohn's disease and the insurance companies love to deny Humira and other Crohn's drugs for any reason they can find because they are extremely expensive. I have mild Crohn's and my doctor decided against Humira simply because he thought it would get denied. They want you to try literally everything else before the heavier treatments, which is completely insane and destructive.
If they can find a clinical trial being run in their area, that is the way to go. They will get excellent, attentive care for free or will even be paid a stipend.
If they can find a clinical trial being run in their area, that is the way to go. They will get excellent, attentive care for free or will even be paid a stipend.
Posted on 7/15/20 at 12:20 pm to Shotgun Willie
INsurance companies dictate care now..
it's total horseshite.
they're the gatekeeper who decides what you can or can not get as treatment
it's total horseshite.
they're the gatekeeper who decides what you can or can not get as treatment
Posted on 7/15/20 at 12:21 pm to Boudreaux35
quote:
Let me guess, pre-existing condition?
No such thing anymore.
Posted on 7/15/20 at 12:22 pm to Shotgun Willie
Yeah, I'm dealing with a knee issue and they denied the MRI request. frickers
Posted on 7/15/20 at 12:22 pm to SuwMwf
There are patient advocates you can hire to work with Aetna.
—-Yes. Tell them to go this route and be persistent and polite
—-Yes. Tell them to go this route and be persistent and polite
Posted on 7/15/20 at 12:24 pm to usc6158
Like with all specialty meds, the incident rates dictate cost. Crohn's just doesn't have the population of patients to lower the cost. Think of it like Hemophilia. So, when the AWP of a specialty med is thousands at Big Pharma, Big Insurance will do anything to try to avoid paying for the claims or at the very least, delay them.
Posted on 7/15/20 at 12:24 pm to Lawyered
quote:
INsurance companies dictate care now..
it's total horseshitee.
they're the gatekeeper who decides what you can or can not get as treatment
Not technically in this case.
If you want treatment, get it, and pay for it.
That isnt a gatekeeper.
People wonder why insurance is so expensive. But never really ask why insurance is so expensive.
Regardless of plan or carrier in this country, the expectation is that 100% is covered.
That isnt how insurance works in other countries. Insurance is so inclusive in this country, it is a rare reminder of processes or exclusions that crop up like this.
I agree that the denial sucks. It doesnt sound like the doctors office is being proactive enough for you... or being honest with you that about expectations within the policy.
Posted on 7/15/20 at 12:26 pm to Shotgun Willie
Dealing with this with Anthem, which isn't any better.
Wife (no pics) has plaque psoriasis and the dermatologist prescribed Cosentyx. Denied for the same reason- didn't go through all the other options first. Cosentyx sent her the first year's worth of treatment direct to the house for free, and I have to say it worked liked a charm. No visible signs after 3 months of treatment.
Wife (no pics) has plaque psoriasis and the dermatologist prescribed Cosentyx. Denied for the same reason- didn't go through all the other options first. Cosentyx sent her the first year's worth of treatment direct to the house for free, and I have to say it worked liked a charm. No visible signs after 3 months of treatment.
Posted on 7/15/20 at 12:27 pm to Shotgun Willie
Posted on 7/15/20 at 12:28 pm to Boudreaux35
quote:
Sounds like they should have gotten pre-approval. Maybe they didn't know, but the Dr should have.
They actually tell you preapproval is not a guarantee of payment.
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