Monday, October 16, 2006


I just had a call from Maureen. She said she heard from the "nurse" at Aetna and that they were sending my file to the Medical Director for review. What does that mean? Maureen said she would be "very very surprised" if the claim was approved because Dr. B. put in for a three level replacement. She said she has never ever seen any insurance company pay for more than one level.

So what's next? She said once they deny it, I'd get a letter saying so and telling me what the appeal process is so that I can proceed with my appeal. My appeal. I asked what that meant and she said that they'd sent all the clinical information to them and on the appeal it was up to me to say what I think the appeal should be. Then she hemmed and hawed and tried to get off the phone. Can anyone explain this?

I'm lost, and sick with discouragement.

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