Question:
Can Aetna make you abide by new rules if pre-cert was prior to change?

A Dr. from Aetna told my Dr. that I would have been approved under the former guidelines but now it wouldn't. My request was on Dec 4 with no word from them until I contacted them on Jan 10! Anyone with any knowledge about this? I'v been denied on appeal.    — toni S. (posted on March 4, 2003)

March 3, 2003
My request for surgery was submitted in December and I received my approval on January 3 (with only a letter saying I had a supervised diet). It is my understanding that they changed the "rule" as of January 17. Don't let up on them.. if you submitted in December, then they should go by Decembers guidelines.
   — SarahC

March 4, 2003
I've been hearing this issue come up a LOT more frequently lately. What exactly does your approval letter say? Mine has a valid period on it. Definitely do NOT give up. AND document, document, document. Names, titles, phone numbers, dates, times, conversations, correspondence. Do NOT give up and if need be hire an attorney that specializes in this type of issue. Good luck!
   — Diane S.

March 5, 2003
I too have been denied via the new rules by Atena and have been fighting them. My next step is to get the lawyer and have him fight it out with them.
   — Sue T.

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