Since when has "Physical Therapy" been considered "Experimental?"

[OhioChick]

One of my kids has had a chronic pain disorder for quite some time and has gone to Physical Therapy for years. My health insurance has always paid for it, as it's necessary, recommended for his condition and brings his pain level down a few notches to a bearable level.

Anyway, I received the EOB's from the past few visits and they refuse to pay.....stating that "Physical Therapy is an experimental procedure." :wtf:

Regardless, now I have to PROVE that it's necessary, even though they've paid for it for years. I'm growing very tired of appeals (and losing) as well as paying more and getting less.

Thanks, Aetna. :grr:

[Canuckistanian]

1. I'm sure they would call setting broken bones 'experimental'

If they could get away with it.

[The Velveteen Ocelot]

2. I was going to say something like, "Are you fucking kidding me?!?"

But I know you're not, and that's just heinous. For-profit health insurance ought to be as illegal as other social evils like child pornography and heroin.

[DesertFlower]

3. they are so full of shit. they

don't want to pay for it anymore.

[The_Casual_Observer]

4. "Aetna, I'd like to forget ya"

[WillYourVoteBCounted]

5. ask doctor to write a letter. INS cos have to do more than cover CEO's bonuses

a letter from your doc should help.

[OhioChick]

7. They have letters from his primary & specialists (Medical Necessity) on file already. n/t

[Odin2005]

6. It's called an excuse.

[appal_jack]

8. Funny...

When I was in a bit of a car wreck, the Doc. wrote a recommendation for Physical Therapy OR Chiropractic to help with my neck pains. Since I already hd a good relationship with a local Chiropractor, I tried to go that route. Immediately, my insurance co. claimed that chiro. was less effective than PT, so they wouldn't cover the two visits that it took to get me back into top form.

For the $100, I decided it just was not worth fighting, so I paid out of pocket.

Methinks that private, forprofit insurance companies will say whatever they want to keep our $$ in their pockets.

-app

[elleng]

9. AMAZING!

My daughter tore her acl in a skiing accident some years ago, and after surgery, physical therapy was recommended by her surgeon. Blue Cross/Shield covered it and monitored it. My daughter's experience was so good that she talked to the therapists several times, worked with them for college credit for a while, and is now studying for a masters (in OCCUPATIONAL therapy.)

I'm mentioning this because we're covered thru the Federal Employees Health Benefits plan, and have selected the Blue Cross plan forever. As I recall, last time I checked, Aetna was more expensive and otherwise less desirable. I know that the plans OUTSIDE FEHB can be and are different, but its very interesting to me that at least your experience suggests that Aetna isn't interested in competing with BC/BS to some extent.

NO thanks, Aetna!

:thumbsdown:

[flyarm]

10. A friend of mine has a blood disorder and has had Flibotomy's ( SP?) done for several years now

she just got a notification that her insurance is not paying for it any more..no reason and no justification..just that they will no longer pay for her very needed blood transfusions!

She is in Calif..but the bill in front of the senate will do nothing for her now..nor for many years to come!

[alfredo]

11. The CEO needs a new Maserati. They might be trying to

force you into resorting to pain killers. They are cheaper than physical therapy.

[madamesilverspurs]

12. Aetna pressured my brother's employer

to fire him when his son was diagnosed with cerebral palsey. In your son's case, one wonders what took them so long.

I despise Aetna. For me they are the ugliest face of a very ugly industry.

-

[one_voice]

13. Are they doing anything new?

Are the physical therapists doing any new treatments? Something your child hasn't had done in the past?

Sounds stupid, but that's how they work. One little thing changes, one "new" treatment and all of a sudden it's not covered.

I used to work for an insurance company...two actually and let me tell you they're the slimiest S.O.B's out there. They play they deny..deny game hoping that you'll give up.

Don't let them win. Make them show you how and where in your contract the treatment is experimental. If they're not doing anything new or different make them (in writing) tell you why it's now experimental. You have to be as tenacious as they are.

They want you to give up, that count on that.

I'm sorry you have a child that's ill. I too live with a chronic pain condition and I know how hard that is as an adult, it must be really hard for a child.

[OhioChick]

14. No, same exact treatment.....

I've even checked with his Physical Therapist and they've used the same procedural codes for years now.

Oh, I won't give up...unless I'm forced. I'm just growing tired of all this. You know.....the old: "We never got that claim...please resubmit" and so forth. Thanks for your advice and thoughts. :)

[ChromeFoundry]

15. What's with the Unrec's? Corporate shills on here..or what?!

Sorry to hear this. Didn't Aetna's CEO just get a healthy bonus?

[immoderate]

16. Do you have a small claims court?

If you sue them there (it's usually nominal) they have to be represented by an attorney. And they are afraid of court rulings, so they will settle with you.

Disclaimer: I am not a lawyer. This tactic was revealed to me by a former colleague who used to sue the health insurance company every year for all his deductibles and co-pays.

[OhioChick]

19. Thanks for the tip....

I have tried saying "I'll have to contact my lawyer" and was told...."do as you wish."

[immoderate]

20. The good thing is that you don't need a lawyer in small claims, but they do.

Also, your action may get the attention of someone who would rather resolve the issue than submit to adjudication.

It would be nice if someone who actually knows something would comment on this. This place is usually crawling with lawyers. :shrug:

--imm

[blueworld]

17. They're gearing up; they can't cancel the policies or refuse pre-existing conditions so...n/t

[TalkingDog]

18. According to BCBS NC the review board can declare aspirin

(or anything else) an experimental protocol. That is...if they choose. And by that I mean, if it puts money in shareholder's pockets. And by that I mean: Anybody who owns ANY stock in insurance should DIE AND GO STRAIGHT TO HELL....along with EVERY STINKING EMPLOYEE DOWN TO THE JANITORS who enables the greedy vultureous bastards.

But other than that...I'm okay with it.

[Therellas]

21. that really sucks.

i wish i lived in country that cared about its people
look into yoga for your son.

[elehhhhna]

22. Ask them in writing what alternative pain control methods they advise...

depending on the answer you might then 1) sue them for practicing medicine w/o a license and/or 2) make a massive media stink about he FACT that AETNA denies your child some simple physical therapy but offers him frikkin buckets of narcotics instead.


If you have a large co. as employer, ask the hr/benefits people to intervene.