Aetna and appeals.

Can someone tell me how to get through to Aetna and their appeals department. Everytime I call they state that the appeals department don't have any access to the phones.  I ask to speak to a manager and they say oh they are going to tell you the same thing I am going to tell you. I am mad, I need to know why I have to do a second level appeal and  send in paperwork that you already have. Here is my story.........I wrote a couple a days ago.

I just have to vent somewhere. I wish I wasn't at work so I could scream to the top of my lungs. I am so mad right now.  I submitted my information to Aetna on May 11th. They promptly denied me stating that I didn't meet the weight criteria for two years. I submitted an appeal on 05/27/11 and showed that I met the criteria. So I just happened to call Aetna today just to check on the appeal. I wasn't expecting anything because they said it would take 30 days. To my surprise they had already denied my appeal, & get this, the appeal was not denied for what it was denied for the first time. This time they claim that I didn't get psych clearance. THAT's A LIE, I told the rep (It just slipped out of my mouth). So she claim I have to do a second level appeal. I said for what the info has already been submitted and I was cleared.  I said let me speak with someone in appeals so I can let them know that they have the info. They don't accept phone calls. WTF. I am pissed. I feel like they are giving me the run around  So I called my surgeons office and called the therapist to make sure I was cleared and that the info was submitted the first time which it was. I just want to take my fist and pound the top of the appealers head. Aetna couldnt even tell me how long a second level appeal takes. I am so MAD. So now I am going to fax my clearance to Aetna my self. I don't trust them. they are evil. Can't you tell I am mad...Any way thanks for letting me vent.......
 

You are going to have to settle down and resubmit. The process is horrendous with many insurers (I took attempted WLS in 2000 and didn't succeed and retried in 2007 with a different insurer). Shouting things like "that's a lie" to someone on the phone is useless. They've made an error and it will be up to you to provide whatever documentation they require. It's not fair but you're the one seeking the surgery. Be as cool and professional during any interaction as you can be and do not lose your temper. If you annoy **** individuals in the system off you will only set up more roadblocks for yourself. Settle down and cross the t's and dot the i's all over again. Many of us have been through it. Good luck. Susan

I know you are right Susan, and I usually handle situations like this with ease. But I am so furious because I feel like those head boppers are in the appeals department bopping their head with a stamp in hand stamping denied , denied, denied on everything that lands on their desk. I feel like they are messing with my life. It should be a law against their tactics. But from now on I am going to keep my cool and handle things professionally.

Hi Rekeca, don't let the process frustrate you. Quite often it's "the last man standing who get's the prize.". Half of their process is to get you to give up your fight; don't give them the satisfaction. If I were you I would resubmit the same information along with the proof of psychological assessment and be clear on your title page that this is an amended 2nd appeal, addressing what they state is the missing component. This time send it Fed-ex, which requires a signature. This is what I told you would happen when you send it via fax. Also address it letter to Aetna Insurance, the appeals dept. And the local Better Business Bureau and/or the local states attorney's in your area... Make sure you note your concern that you feel your file has been mishandled and regarded carelessly. But whatever y do, don't give up and don't give in. Jil