Question

Can Aetna exercise a 45 day extender to render a decision on my appeal?

Asked on September 7th 2016 by Tiffany
I have been a migraine sufferer for over 10 years and recently had to stop taking my medications that were helping to reduce the number of migraines that I have due to pregnancy. I spoke to my manager at work as well as my OBGYN and neurologist (who I’ve been seeing for the past 10 years) and they all agreed that I needed to be out on STD due to the consistent migraine that I have had since my second trimester began end of May 2016. On top of the migraines I was diagnosed with Gestational Diabetes making my pregnancy high risk and having been put on medications to help stabilize my glucose levels which have been elevated due to the stress of the situation and the migraines. I filed a STD claim with Aetna June 9, 2016 which was denied July 1, 2016. I immediately submitted an appeal request which started on July 12th and just now received a letter stating as of September 7th is going to be extended an additional 45 days til October 25th due to them “pending the results of several requested specialty matched medical opinions on my claim file.” I was told that their neurologist, who has never examined me, spoke to my neurologist of 10 years and that “it did not go in my favor”. I have faxed them every document that they requested within 24 hours and have been following up with both my OBGYN and neurologist, having both send over the doctor’s notes within 24 hours. Now they tell me they need an additional 45 days for what? They have not requested any additional paperwork from me or my physicians. At this point I am three months out of pay and living off of credit cards to try to keep up with my household bills. I have a baby that is due in 8 weeks and no way to be financially ready for this child due to not getting paid and unable to return to work until after the delivery.

Answer

Answered on September 8th 2016 by Attorney Stephen Jessup

Tiffany, during the course of an appeal Aetna can exercise a 45 day extension to render a decision on the appeal, so they are within in their rights. That being said it from what you are saying it does seem strange that they would exercise it. Please feel free to contact our office to discuss the claim further.