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re: Insurance Denial...Aetna Sucks

Posted on 7/15/20 at 12:29 pm to
Posted by Harry Caray
Denial
Member since Aug 2009
21045 posts
Posted on 7/15/20 at 12:29 pm to
quote:

Let me guess, pre-existing condition?

Let me guess, another tax paying American citizen getting fricked over by his country's health system for *checks notes* being born with less than perfect health
Posted by Hangit
The Green Swamp
Member since Aug 2014
47792 posts
Posted on 7/15/20 at 12:49 pm to
My wife has thrombotic thrombocytopenic purpura. (TTP) 9 people out of a million get it so there are few studies. She ehas been through countless rounds of plasmapheresis and 3-4 rounds of chemo. The chemo has to be pre-approved every time.

I have an aortic aneurysm. (5cm) My thoracic surgeon said it is dangerous and he wanted to fix it. Insurance said not to fix it until it reaches 6 cm. 5 cm is the generally accepted fix point. Yet, here we are. Thanks, Cigna.
Posted by Cdawg
TigerFred's Living Room
Member since Sep 2003
62228 posts
Posted on 7/15/20 at 12:58 pm to
quote:

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.

Amen. All of it is horseshite and entire system is broken.
Posted by holmesbr
Baton Rouge, La.
Member since Feb 2012
4202 posts
Posted on 7/15/20 at 1:17 pm to
I had a few rounds of Remicade about 20 yrs ago. Guess what? Insurance denied it then also. $2500 a pop. My Dr said it was still $$$. $30k is high. Maybe all total.
Posted by Henry Jones Jr
Member since Jun 2011
77943 posts
Posted on 7/15/20 at 1:19 pm to
quote:

for-profit insurance companies suck.
If insurance companies don't run a profit, then there's no insurance and nobody gets coverage
Posted by RT1941
Member since May 2007
32318 posts
Posted on 7/15/20 at 1:29 pm to
quote:

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.

The doctor's office should've ran the treatment plan through insurance and counseled the family BEFORE the doc started treatment. They'd know up front whether the insurance would cover the expense or not and if it wasn't covered the doc could start with an alternative treatment to see if it showed results. The dr's office needs to be persistent but firm.
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