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Aetna / claim review

1 United States

My wife was deined coverage my Aetna. Once I received a bill from the doctor's office in March I reviewed the EOB's and contacted Aetna. I was told I would need a letter of "Medical Necessity" stating this work was in conjunction with the breast lesion removal and biopsy. The doctor's office sent a letter to Aetna stating this on 3-22-18, Aetna received the letter 4-3-18 with their confirmation number [protected].
On 4-6-18 I called Aetna and was told that they had the letter and the claim would be reprocessed based on the information. I did not think to get a confirmation number that day. I was told 5 to 7 days to reprocess.
On 4-16-18 after no response from Aetna I called again. I spent a half hour on the phone while they looked for documentation. I was told the claim had not been sent back for processing but they had all the necessary documents and it would be reprocessed. Aetna CNF #[protected].
On 4-23-18 I called again as I had no response from Aetna. Again I was told the claim had not been sent back for processing. I spent another 45 minutes on the phone while the documentation was found again. I was told it would be sent back. Aetna CNF. #[protected]. Then the representative that I was talking to said " but call back in two days and ask to speak to a supervisor".
So on 4-25-18 I called and spoke to a supervisor for another 45 minutes. The claim still had not been sent for processing and I had to explain the entire narrative again. He spent time to again gather the documentation and he said he was sending it to " Complaint and then Reprocessing" and it would take until May 10th to resolve. The CNF # yesterday was [protected] and he gave me a case ID number [protected].
On May 23rd I called to try and get some resolution or information and at that time I was told that the claim was in Appeals and would be resolved by May 23rd. I said what happened to the 10th. I was told the records they had did not say May 10 anywhere.

Da
May 7, 2018

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