Aetna Corporate Review  Denies Coverage The timing worked well for Aetna in the end. They were able to frame the reimbursement of past expenses as administrative errors, thereby negating the need to pay going forward or acknowledge any medical benefit. By reimbursing just before the Fox story aired, they come out smelling like a rose. There was still the formality of the promised Corporate Review the following week. The 40-minute conversation featured us, our advocate Dr. Paul G. Harch and an impressive cast of characters from the upper echelons of Aetna including their National Medical Director, Chief Medical Officer, attorneys and nine senior Aetna physicians. We had little expectation for success and the swift denial of any future claims was easily forecast. Nonetheless, we came away with a David vs. Goliath sense of accomplishment akin to Rocky Balboa losing the fight but lasting all 15 rounds. Aetna came to an inevitable corporate conclusion, but not by dismissing us out of hand and hoping we'd go away but by taking the time to consider our claim and possibly opening their eyes to future concerns of other subscribers. To download a 16-page transcript of that review and the subsequent letter of denial, click below. Our surname has been removed for reasons of privacy. Click here to download a transcript in PDF format. We went forth with one more half-round of HBOT following Aetna's ruling. On January 26, 2010, Miranda turned three and entered a wonderful special needs preschool. She nearly wasn't accepted because all but one test score was within the average range. We have every expectation she will enter a typical kindergarten class when she turns five. We will continue to update this web site as time allows.

Aetna Corporate Review
Denies Coverage

The timing worked well for Aetna in the end.

They were able to frame the reimbursement of past expenses as administrative errors, thereby negating the need to pay going forward or acknowledge any medical benefit.

By reimbursing just before the Fox story aired, they come out smelling like a rose.

There was still the formality of the promised Corporate Review the following week. The 40-minute conversation featured us, our advocate Dr. Paul G. Harch and an impressive cast of characters from the upper echelons of Aetna including their National Medical Director, Chief Medical Officer, attorneys and nine senior Aetna physicians.

We had little expectation for success and the swift denial of any future claims was easily forecast.

Nonetheless, we came away with a David vs. Goliath sense of accomplishment akin to Rocky Balboa losing the fight but lasting all 15 rounds.

Aetna came to an inevitable corporate conclusion, but not by dismissing us out of hand and hoping we'd go away but by taking the time to consider our claim and possibly opening their eyes to future concerns of other subscribers.

To download a 16-page transcript of that review and the subsequent letter of denial, click below. Our surname has been removed for reasons of privacy.

Click here to download a transcript in PDF format.

We went forth with one more half-round of HBOT following Aetna's ruling. On January 26, 2010, Miranda turned three and entered a wonderful special needs preschool. She nearly wasn't accepted because all but one test score was within the average range.

We have every expectation she will enter a typical kindergarten class when she turns five.

We will continue to update this web site as time allows.

Chronicling a Battle with Aetna to Cover Hyperbaric Oxygen Treatment (HBOT) for Our Daughter, Miranda

Editorial

Follow the full story via the below links, listed in chronological order.