I am battling Aetna PPO to cover a diabetic DME (Continuous Glucose Monitor). I hold followed every step/policy Aetna has asked of me to complete this appeal process. I am ANGRY that when I ask something of them, they do not even acknowledge my request! In my ending appeal letter I specifically asked for 4 things from them if they denied my appeal again:
1. Study reference they used to deny my appeal (URL format)
2. Full listings of financial and other relationships which any insurance companies and other payers (such as Medicare/Medicaid, Military “Tricare”, VA, etc.) have beside their study authors.
3. Medical license numbers of their decision maker(s).
4. An appropriate decriminalized contact’s address.
My questions is: Do I purely go ahead next to my next appeal, or do I telephone call them up on not supplying me with the information that I requested and emergency that they do it?
Thanks for your help
Marcy
Answers: You progress ahead with your subsequent appeal.
they aren't required to "honor" any requests.
The legal contact for complaints, is your state insurance department - you can acquire the contact info on their website.
The answer to your questions can be found on their public website. They sited more than 77 resources, some be medical organizations. If you want industry standard information shift to the fda's website. Why do you want the license #s of all the doctor's who participate in research? I'm not sure how that would assistance your appeal...
This device is still usually considered experimental by every insurance company I checked online. If you are trying to do something with the information provided, biddable luck. If you're asking in the hopes they can't provide you the notes, I'm not sure how to help. But, seemingly, my post answers most of your question.
Corporate address:
Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156
USA
Continuous Glucose Monitoring Devices:
http://www.aetna.com/cpb/medical/data/1_...
Aetna considers continuous glucose monitoring devices (e.g., MiniMed Continuous Glucose Monitoring System, Guardian Real-Time Continuous Glucose Monitoring System, and the DexCom STS), which are used to continuously monitor diabetic persons' blood glucose levels over a three-day (72-hour) time of year, medically necessary for those with type 1 diabetes who own either of the following problems within controlling blood glucose level, unresponsive to conventional insulin dose adjustment:
1. repeated hypo- and hyperglycemia at impossible to tell apart time each time; or
2. hypoglycemia unawareness.
No more than two CGMS monitoring periods are considered medically called for within a 12-month interval. Aetna considers the long-term use of continuous glucose monitoring devices for home self-monitoring of blood glucose experimental and investigational.
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1. Study reference they used to deny my appeal (URL format)
2. Full listings of financial and other relationships which any insurance companies and other payers (such as Medicare/Medicaid, Military “Tricare”, VA, etc.) have beside their study authors.
3. Medical license numbers of their decision maker(s).
4. An appropriate decriminalized contact’s address.
My questions is: Do I purely go ahead next to my next appeal, or do I telephone call them up on not supplying me with the information that I requested and emergency that they do it?
Thanks for your help
Marcy
Answers: You progress ahead with your subsequent appeal.
they aren't required to "honor" any requests.
The legal contact for complaints, is your state insurance department - you can acquire the contact info on their website.
Um can someone recommend an insurance company?
The answer to your questions can be found on their public website. They sited more than 77 resources, some be medical organizations. If you want industry standard information shift to the fda's website. Why do you want the license #s of all the doctor's who participate in research? I'm not sure how that would assistance your appeal...
This device is still usually considered experimental by every insurance company I checked online. If you are trying to do something with the information provided, biddable luck. If you're asking in the hopes they can't provide you the notes, I'm not sure how to help. But, seemingly, my post answers most of your question.
Corporate address:
Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156
USA
Continuous Glucose Monitoring Devices:
http://www.aetna.com/cpb/medical/data/1_...
Aetna considers continuous glucose monitoring devices (e.g., MiniMed Continuous Glucose Monitoring System, Guardian Real-Time Continuous Glucose Monitoring System, and the DexCom STS), which are used to continuously monitor diabetic persons' blood glucose levels over a three-day (72-hour) time of year, medically necessary for those with type 1 diabetes who own either of the following problems within controlling blood glucose level, unresponsive to conventional insulin dose adjustment:
1. repeated hypo- and hyperglycemia at impossible to tell apart time each time; or
2. hypoglycemia unawareness.
No more than two CGMS monitoring periods are considered medically called for within a 12-month interval. Aetna considers the long-term use of continuous glucose monitoring devices for home self-monitoring of blood glucose experimental and investigational.
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