Sunday, June 12, 2011

Burst My Bubble

Yesterday I recieved a letter from Aetna.

I assumed it was just an Explantion of Benefits as I get them regularly...but my heart skipped a beat when it stated that the insurance company has made a decison about coverage for Percutaneous Implantation of Neurostimulator Electrodes.

It read:  Coverage for this service has been denied for the following circumstances...

(Now I will spare you the two page details, but one part that got me was where it said):  "Aetna considers use of cervical spinal cord stimulation for the treatment of members with disc herniation, neck pain, and/or cervicogenic headache.  Based on the clinical rationale provided above, coverage is denied as not medically necessary under terms of your benefit plan."

Are you fucking kidding me?!? 

Even if I put aside my diagnosis of Basilar-Type Migraine, my diagnosis of fused cervical vertebrae, bulging discs and bone spurs which in turn cause constant cervicogenic headache should be enough. 

Seven years of medication, surgery, injections, and other various treatment still was not enough to convince them that my quality of life is diminished and a Neurostimulator may be beneficial.  At least allow me the trial implant for crying out loud!

I suppose Aetna would rather another member of society be walking around hopped up on opiates and muscle relaxers.

Way to go insurance companies....you suck!

9 comments:

Della said...

Can you appeal this decision? Can a doctor go to bat FOR you with Aetna? I'd like to know what gives them the right to deny without even contacting the patients medical team. It's just not fair!

Heather said...

I sure hope you can appeal this decision! I agree with Della, maybe your doctor can go to bat for you with them. They totally Suck! How rude and mean and everything else I could possibly say to them! This is unfair!

I do hope you are able to get this device or at least the trial of it and that it works for you! Oh my!!!!!!!!!! I am mad at them with you!

Jessica said...

We are still fighting!

Jamie said...

Jessica, I'm so sorry. I hope you have luck appealing the decision. I have Aetna, and they approved my Neurostimulator... but it did take some time and my doctor's office helped a lot. I hope you can get them to at least approve the trial.

Migrainista said...

"...not medically necessary under terms of your benefit plan." Since when is medically necessary based on what insurance plan you have? Doctors should be the ones to determine what is medically necessary, not insurance companies I'm so sorry to hear that they will not even let you try it!

Jessica said...

My dr is optimistic and is also helping to fight the decision...so it may turn out ok. But it is annoying that insurance companies are allowed to over ride a physicians diagnosis and treatment plan!

S.I.F. said...

Dispute it Jessica! Disspute, disspute, disspute! My last surgery was also denied... it's amazing how fast the insurance companies give in when you fight this stuff though!

Sue said...

Aw crap.I do so despise insurance companies. This is yet another reason why. I'm so sorry.

Jessica said...

I love the support and encouragement from you all! You rock! Lots of love!!