Question:
1s appeal denied now what

I called Aetna today and my 1st appeal was denied. They said I need to go through the my husbands Human Resources department for my next appeal; Is this worth it, or should I hire Walter inmediately? The Aetna appeals department is telling me I should go through the Hr Department 1st, but they are also telling me this will be my last appeal.    — Gilmaris M. (posted on July 30, 2002)

July 30, 2002
The reason they are telling you to go through your husband's HR department, is because your company is probably "self-insured," meaning that the company tells them what they can and cannot cover. I don't imagine suing the insurance company in this case would be even remotely useful. They are bound by the company's rules. Yes, definitely, talk with your husband's HR department. They hold the purse-strings in this case. Might be worth you getting a job with insurance elsewhere.
   — Terissa R.

July 30, 2002
BEFORE I USED MY LAST APPEAL, I WOULD GET WITH YOUR EMPLOYEER AND MAKE SURE THEY DO NOT HAVE AN EXCLUSION. I WOULD GET THE EXACT REASON THEY DENIED ME, AND MAKE SURE I HAVE ALL MY BASES COVERED. THEN I WOULD DECIDE IF I WANTED TO GO TO THE ATTORNEY. JUST BECAUSE THEY SAY IT'S MY LAST APPEAL, I DON'T THINK I WOULD LET IT GO.
   — Pam G.

August 1, 2002
Your husband's employer has to approve or deny the procedure. It's out of the insurer's hands. They are either self insureed or they can authorize this as an extra-contractual benefit.
   — margaret N.

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