My mom was set for surgery on her back later this month (June 2024). She has been living with absolutely EXCRUCIATING pain for over a year and a half, as a result of 2 herniated disks in her lower lumbar.
They set the surgery for 6 months out so that she could lose weight ahead of surgery (she weighed about 270 and they wanted her to drop 30lbs for safety.) She worked hard and has lost FORTY POUNDS, bought supplies, I have plane tickets to go take care of her for the first week following her surgery, she has made so many arrangements ahead of this.
Suddenly, with only 3 weeks to go before this surgery that will finally alleviate her unbelievable pain, her insurance company (Aetna) had DENIED HER CLAIM. They demanded an MRI and SIX WEEKS of physical therapy before they would greenlight the surgery. Now she will have to wait months for availability to open up at the clinic once the physical therapy is done and her claim, ideally, approved.
I am horrified. Livid. Boiling over. I feel so helpless and desperate. Does she have any recourse at all? Can she do anything to fight this? Can she appeal it? I want to call them and lose my mind on whoever refused her surgery, but I have no idea how or where to start.
If anyone can help, please let me know… thank you!
Surgery claim denied 3 weeks out
byu/littlemissdrake inInsurance
Posted by littlemissdrake
3 Comments
The health insurance dispute process is well established, both pre and post treatment. Contact you state insurance commissioner for the process.
Has she had an MRI or physical therapy? Those are such standard treatments and diagnostics that I cannot imagine a physician doing surgery without those having been done first (other than an emergency, but they wouldn’t make her lose weight in an emergency). Can you verify with the insurance that she has, in fact, completed these in case they are not aware?
Have the dr do their work to get it approved. Im on aetna and had 6 spinal surgeries and a toe fusion. The only one that was cancelled was my toe fusion, they called to go over my surgery details 2 days prior to surgery and asked if I stopped smoking. I imformed I dont smoke, but I dip tobacco. She said thats the same as smoking, and I asked her how but she couldnt give me a reason, because she has no idea how smoking cause thousands of carcinogens when the cigarette is lit and smoked, tabacco does not. So I told her, you’re a hospital you need to specify no tabacco or nicotine use for 6 weeks prior. It took me a year to quit dipping, but I did and got my toe done. I should have kept dipping, big toe fusion was the worst decision of my life.