Aetna

Aetna ignored my very detailed medical information and denied my claim

Reviewed by Tanya S on July 21st 2016   Verified Policyholder
I was discontinued LTD after the 24 months, although there was never any question about receiving the LTD prior to that. My doctors notes are all quite detailed, yet they used an initial specialist, from the beginning of my treatment, who suggested that I not take the meds I was was for Fibromyalgia. I then went on to try every other medication suggested, with disastrous side effects (one requiring and ER visit), until with further testing it was determined that I have Ehlers Danlos syndrome (Fibromyalgia is still on the diagnosis in my charts, but the reasons for the narcotic pain medications are severe back pain, and overall body and joint pain from the Ehlers). The denial completely disregarded the very detailed information regarding what I can and cannot do that my doctor sent after every visit, the new diagnosis of Ehlers Danlos, the worsening disc degeneration in my back, as well as side effects of the medications I take for any quality of life. In the denial, one of the occupations they said I could do was the one I had been doing prior to having to leave work. It involved lots of driving, lots of sitting, extreme levels of stress to maintain schedules, deadlines and documentation of work performed in the course of my job. These things were all addressed, over and over, in the course of my treatment with my PCP and other specialists. The denial even went so far as to say that I owed them money for an overpayment. When I received the administrative chart, it was glaringly apparent that all the people who signed off on the denial did not review the chart in any detail, as there was another person’s information in my file, that was sent to me. (I did file a complaint due to the HIPAA violation.) There was information from the investigator regarding social media posts, none of which contradict anything I claimed within or without my abilities, except one, but that picture was taken prior to leaving on disability, and in fact had been addressed in a notarized statement when I appealed the denial from short term to long term (which they obviously did approve). There was information from the investigator regarding social media posts, none of which contradict anything I claimed within or without my abilities, except one, but that picture was taken prior to leaving on disability, and in fact had been addressed in a notarized statement when I appealed the denial from short term to long term (which they obviously did approve).
Reply
Sent on July 21st 2016 by Attorney Stephen Jessup

Tanya, it is imperative that you submit your appeal within 180 days of the denial or you could be barred from bringing suit. Please feel free to contact our office to discuss your claim and how we may be able to assist you with the appeal.