Aetna Private Insurance through Employer

[Ronn1708]

Has anyone had an implant using Aetna Private Insurance that is provided by your employer?? I am just trying to see if they cover the surgery. I called and the rep said they do but requires preauthorization. I called the doctors office and was told they generally reject covering it when its a private policy through an employer. She said if it was medicare it generally does cover. I think Precertification has been submitted but usually takes two weeks for response...
Thanks!

[Gt1956]

I had Aetna. Once I retired & moved to Medicare I switched to an Aetna Advantage plan. I did have coverage thru Mecicare. I'm not sure how or what Aetna covered. I recently learned that the anesthesia doesn't do billing. I need to pass the bill to the approriate companies. I had run into this before with a surgery my wife had. I'm hopeful that at worst I'll have a modest copay.

My advice, ask your drs billing staff about your Aetna coverage. They have more experience dealing with implant coverage than anyone you can reach by phone.

[nerdynerd]

My advice, ask your drs billing staff about your Aetna coverage. They have more experience dealing with implant coverage than anyone you can reach by phone.

This. When I called BCBS they said it was covered, but then when the surgeon's office contacted them it was denied due to an exclusion in my company's policy. I waited a year and enrolled in Medicare.

[jdsatx1977]

Has anyone had an implant using Aetna Private Insurance that is provided by your employer?? I am just trying to see if they cover the surgery. I called and the rep said they do but requires preauthorization. I called the doctors office and was told they generally reject covering it when its a private policy through an employer. She said if it was medicare it generally does cover. I think Precertification has been submitted but usually takes two weeks for response...
Thanks!

We had Aetna last year and I was denied. Went through the appeals process, and was told they would approve it if my do used a different diagnosis code. Makes no damn sense to me. My doc agreed and said we will try again this year. We have Cigna now so who knows if they will approve it.