First thing i did was check my claims online and sure enough i saw that it was denied – great! Anyhoo, so i made the call. Come to find out that it was denied because it wasn’t pre-certified (approved) by Aetna…and then the lady said if it isn’t pre-certified the only time it might be paid is if the doctor diagnoses it as an emergency. So i said, “well it was an emergency – i’d fallen and was in the ER.” i was told that since i was coherent I should have told the ER nurse/doctor to make sure and pre-certify the scan before anything was performed. I told the woman that that was the dumbest thing i’d ever heard. I mean who has time to think about those issues when u are in an ER and worried about whether or not you’ll come out in 1 piece or what they are going to tell is going on in that body.
while she was spouting off at the mouth, i continued looking at my claims and noticed yet another 1 was denied – the last MRI. i asked her about that one – and again she told me that it wasn’t pre-certified. Now that, i’m mad about. The MSCA had no business doing it without it’s being pre-certified – they ALWAYS do it. Now y they wouldn’t do that this year? who knows!
On the upside, i haven’t gotten any bills from either place (YET?!?)…so I haven’t gotten my panties in a bunch or putting on my armour to go to battlle with anyone – YET!!!
