Question:
What does this mean when my ltr says I am denied but surgeon say I am approved?

Friday, my initial letter to insurance went out, and only three days later, I got a call from the surgeon's office, saying I'd been approved by Aetna/USHC-HMO. Today I got a letter in the mail from Aetna, saying I was denied! Which one is it? It read that the bypass was questionable due to malabsorption issues. I know for a fact they've paid for others to have it before. My balloon of excitement has suddenly burst. I'm calling both surgeon and insurance tomorrow, but in the meantime, has this happened to anyone before? What next?    — Amy K. (posted on March 2, 2001)

March 1, 2001
Update: I have since talked to insurance, who told me to have the lady from surgeon's office call them. When I told her the deal, she knew about it before I could get the words out. She said Aetna uses a different CDT code than most insurances, so they expected to get the denial letter. It's only a matter of using a different code number. So I am approved! I hope this helps other Aetna users. You may actually be approved, even if you get a denial on the particular basis of bypass being "questionable." That's not to say this would be for other reasons stated in a denial letter.
   — Amy K.

March 2, 2001
CONGRATULATIONS!!! I'm so glad you're approved. It's terrible to have to go through an ordeal like that.
   — Betty Todd