Unbelievable.

I’m too upset to go into much detail here, but I just got a letter from Aetna threatening to cancel my policy retroactively.  They suddenly decided that I either lied or omitted information on my application when I first applied for insurance in Dec. 2007.  They requested all my medical records and asked me 8 questions, 7 of which are so vague, I can’t answer any of them.  I have to reply within 10 business days.

Of course, we get this on a Saturday so there’s no answer at the phone number given.  Even so, they probably won’t talk to Dave and I can’t hear on the telephone.  There’s no TTY number given.

I have NO IDEA what to do.  I have heard horror stories about policies being cancelled for totally minor, unrelated things the insurance company decided were omitted from an application.  My surgery, all the doctor appointments, tests, etc. involved cost around $300,000 in total.  If my insurance is cancelled retroactively, I can’t pay those bills back.  As it is, I have over $10,000 out of pocket that I’m paying right now and that is killing us.

All I can say is…if they didn’t want to pay for my CI surgery, why did they approve it?  Yes, it’s horrible timing that I switched to Aetna in January and went suddenly deaf in April, but it wasn’t a pre-existing condition and I had no idea I was going to lose my hearing!  I wish they would’ve just denied the surgery rather than paying and now making me go through this hell.  The questions they are asking are so vague that there’s no way to properly answer them…and I’m sure they do it that way so they can say I lied or omitted information when I respond.

This is a nightmare.  That’s about all I can say.

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About wendiwendy

This was my original info in 2008: I'm a newly-deafened adult. I'm still getting used to the sudden silence, and I want to talk in the only manner where I can still hear my voice...in print. Now: I'm a bionic woman and I can hear myself roar!!

Posted on November 1, 2008, in Cochlear Implants & Hearing Loss and tagged , . Bookmark the permalink. 9 Comments.

  1. oh no thats terrible! I think all bloody CI surgery should be fee to the hospital given etc. We had trouble with funding and we had to fight for it on fo the hospital to do it! it was a night are as well! Hope you get your surgery appoved and it will be all ok in the end! Keep smiling x

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  2. Unfortunately, this isn’t the first time of heard of a situation like this! Ticks me off!

    Listen, Wendy, I don’t know if you have any lawyers in your family or network of friends, but it is very important to answer those questions “the right way”. They many times are looking for “key words” that they hone in on like a heat seeking missile!

    I know that Cochlear Americas has staff that are experts in this area. Contact Advanced Bionics and ask them for the name of someone to whom you can discuss this with prior to filling that out.

    10 business days… that starts Monday?

    I am pretty sure an insurance company cannot cancel insurance “retroactively” … especially when you had to have approval in the first place! If they decided they don’t like the final cost, they shouldn’t have approved it. I’ve heard “Aetna” as one that pays for CI’s, so I’m not sure what this is all about. I wonder if they need some sort of proof that you had sudden sensorineural hearing loss? Perhaps a letter faxed from your doctor?

    Hang on to every name you are in contact with at Aetna so as to leave a “trail” to follow should you need to pursue this even further.

    Head up! You’ll get through this! I’m praying for you!

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  3. Oh Wendi, first of all I am saying a thousand prayers for you as I type.
    Secondly, please contact AB and get advice from their legal.
    Third and very important, first thing Monday retain legal council for you, but try to do research and find a firm that specializes in this.
    If it matters, I do not believe they can get away with this. They will try, but in the end you will be ok.
    You have a fine network of good people behind you.

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  4. Oh Wendi!! Let’s just hope this is some kind of mistake and will get resolved as soon as you can communicate with someone at Aetna on Monday.

    As Laura offered support and Denise and David said, Advanced Bionics will be a great resource for how to handle this and if you have to hire an attorney you’ll be prepared.

    We’re behind you 100%!

    Jennifer

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  5. You should also contact Letthemhear dot org. They have helped people get insurance prior to surgery, but may also be able to help you in this case also.

    I am so sorry that this has happened to you.

    My son was covered with Aetna last November and we didn’t have any issues with them at all.

    Best of luck

    Mom of Bi CI

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  6. I’m so sorry to hear this. Ugh. Those Aetna buzzards are something, eh? Okay, they aren’t buzzards, but they sure are an enemy right now. Like the others said, contact AB or LTHF and see what they can do.

    You’d think that they’d have done some auditing when you got your approval for the CIs. What a mess.

    I’m praying for you, girl. Hang in there.

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  7. Don’t despair. The other commenters gave you some great ideas. You are in my thoughts and prayers!

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  8. I’m so sorry to hear about this. Someone else already gave you the name of letthemhear.org. I’ve heard it’s a great organization. A DVR counselor told me about them last year. I haven’t followed up myself because I need the experiemental hybrid and i’m waiting for FDA approval. But I’m sure they’ll be able to help you and give you advice on how to handle this. Good luck and HUGS! Please keep posting about this as you can. I want to know. Kim W.

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  9. What a nightmare! The advice to contact Advanced Bionics Insurance department and Let Them Hear foundation is excellent. I hope you contact them without haste. My prayers are with you. (((((HUGS)))))

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