Aetna

My doctor checked the wrong box, so Aetna denied me and refuses to listen

Reviewed by Autumn on May 22nd 2015   Verified Policyholder
I had a needed hip surgery on 3/6/15 at Virginia Mason in Seattle and went on short term disability for 12 weeks based on my doctors recommendation. Aetna is the provider for my short term disability. Somehow, the doctors office accidentally told Aetna I will be able to return to work in 6 weeks instead of 12 weeks. Which I was never told. I had no idea until Aetna sent me a nastygram saying that my disability pay and coverage will be terminated immediately on 4/17, 6 weeks too early. And I wasn’t ready to go back to work until 5/29 (12 weeks from 3/6). So I picked up the phone to resolve, what I thought, was a small issue that turned into a huge one. I called the doctors office and they immediately sent the correction back to 12 weeks until return to work. Despite this, Aetna still decided to deny my request anyway and did not want to reinstate my benefits. I have been on the phone with them 2-3x a day for 8 weeks now asking what else they need to reinstate but they have yet to give me any detailed reason that makes sense. I have been speaking with a claims manager who has no power…she said its up to the medical review team at Aetna to decide fate. And I said why? This was a clerical error…I am not asking for an extension of time away from work. Even my surgeon has sent Aetna several custom letters so that they will quit withholding what I need while out of work. I have gone over my whole medical file. There is no data supporting that 6 weeks until return to work is valid. Several times in my physician notes they write that I am on track for my 5/29 return to work, which is 12 weeks. Boeing pays Aetna to administer disability benefits so when I tried to complain to the Washington Commissioner Board say said Aetna is untouchable because they are privately funded by Boeing and they couldn’t help. So I am, mentally exhausted from getting nowhere with Aetna, with no income, no insurance coverage to go to my really important PT appointments, had to move into a new house and my mortgage is due soon, and Aetna couldn’t care less. This just isn’t right. They can’t do this to people. Is there anyone out there who can help? I have all of Aetna’s vague denial letters.
Reply
Sent on May 22nd 2015 by Attorney Stephen Jessup

Autumn, please feel free to contact our office. Unfortunately, it is all too common that doctors check off the wrong box on a form and it allows an insurance carrier the ability to deny a claim.