Dr. Sacco / Dr. Swift Insurance Question

[RyansMom11]

On the phone with Aetna as I'm typing this, at first she said we're all set and now has came back and said two things are approved in network, she not sure what, because the notes don't make sense to her. I'm on hold, she said for sure that our pre-op visit on the 26th is approved at in network rates. She (Aetna rep) is waiting for her call coach to respond. She said a letter was sent out in the mail to us yesterday. David has been sorta helpful, I have the codes if you need them and they are doing the same procedure?

Aetna is back, she is telling me everything is approved!!! I hope!! She said the out patient/ office visit part is for sure approved. She said the surgery part is approved but she wants the notes clarified from the nurse who approved it. They did this really fast! I was told 7-10 days and it wasn't even one day. So I will call back tomorrow to double check everything.

Liz

[jjmc123]

That's great news! Is Aetna sending this to you in writing? I ask as a cautionary tale as they told me that my son's surgeons for his last op (non cranio related) would be covered 100% when in the end, the surgeron was only 75%. Get a letter to protect yourself in case there is an issue with the bill post op.

[tammylh]

Yeah, I figured Valerie was no longer there. They really waited til the last minute though. I think if I don't hear back in a week I'll call and bug Dr F's office. I emailed David at Dr Sacco's office but haven't heard back yet. Hope you get that approval in writing soon.

[RyansMom11]

The letter is supposed to be in the mail. I will call again tomorrow to double check.

Call David at Dr Sacco's office until you get him on the phone, I left messages and emails and never got a response. He basically had me do everything, he just gave me the codes. He thoughts ours wouldn't be approved because we were coming out of state?!? Wtf?!? I know many parents that have gotten them approved ... Oh well guess we'll see tomorrow and see if my letter comes. The procrit was way to easy to be approved so maybe this will be too? I don't know! Hoping that it is approved!

Liz

[crunchymomma]

We have Aetna and they covered Dr Swift 100% (we had met out max out of pocket by the time surgery came around) but I had to fight for it. They are not in network with anyone, but you can request Aetna pay in network benefits. I had to explain that Dr Fearon only worked with those two NS, and it was not up to us as they were a TEAM. They denied my first request, and I appealed. I was actually on the phone with them three days before surgery while in the car driving to Dallas! Our HR department ended up getting involved, and the night before surgery we got word that everything was approved for 100% coverage. Just fight for it!! Feel free to contact me privately if you need help!

[RyansMom11]

I just spoke with Aetna again to reverify and make sure everything was straightened out from before. They have approved both our pre-op visit with Dr Sacco and our in patient, surgery with Dr Sacco, same benefits as Dr Fearon. The letters are in the mail. Hopefully everything I've been told is true, I will keep watching the mail for our letters! The reps were very helpful ... Guess we'll see when our EOB comes ....

Liz

[tammylh]

I just heard back from David at Dr. Sacco's office and he told me I could go ahead and try to get Dr. Sacco paid as in network without Dr. Fearon's pre-cert. So I'll be calling them today.

Glad to hear everything seems to be alright! Looking forward to hearing that you have it all in writing. :)

[tammylh]

Got the ball rolling! I called in to the pre-cert number and gave them all the info for Dr. Fearon and Dr. Sacco. They wanted diagnostic codes and procedure codes, which I had to get from Dr. Fearon's and Dr. Sacco's office. At first they said they needed something from Dr. Fearon's office first, but then right after she said that, she said, well, wait a minute and started taking all my information. They are going to assign a case manager and get back to me.

[RyansMom11]

Got our letter in writing yesterday in the mail! Rec'd two letters one for inpatient and one for our doctor visit with Dr. Sacco (pre-op).

Of course, Ryan spiked a fever Sunday night, seems as tho it's just a virus and he's now fever free!! Ryan got his last procrit shot this afternoon! Just need to pack up and we'll be ready for surgery. Can't wait to be past surgery.

Liz

[tammylh]

Glad to hear everything worked out with the insurance! And that his fever is gone!

I'm still waiting to hear back. They contacted me about why we live in California but having surgery in Texas. But haven't heard anything back since then.

And I can't wait to get past surgery either! :)