Insurance Denial Trick?

[Spiky Bugger]

@Spiky Bugger thank you so much! That's him. I found a Flickr page where he states that he recently became a consultant with them.

That info was part of how we appealed our daughter's breast reduction surgery...and won. We went to FIVE in-network board certified plastic surgeons, who all recommended just about the same thing. Their guy denied it because he wanted so much tissue removed, it was pactically a mastectomy. When we started the appeal, we said that if they wanted to go to a state appeal with THEIR guy...who happened to be an EENT, we'd be happy to go with the recommendations from our five board certified plastic surgeons, all of whom were in network with Aetna (so Aetna must think they are experts, right?) They suddenly announced that there had been a mistake.

But hold on to that info...("keep your powder dry," as they said back in the day)...until you can use it most effectively.

 

[Amey]

I tried this... They told me I had to put a request in writing. So I did. A 4 page letter demanding names and credentials. I didn't get any of that.... But I did get 2 big flat envelopes... About a ream of paper... Of all my medical records the insurance company had on me with a lot of slick talk about confidentiality to protect their employees. My External Appeal with the Department of Insurance is pending...... And the 3 month wait for an answer is killing me.