AETNA AGREES TO REIMBURSE Miranda's Story Airs on Fox 5 New York After several attempts, we were unable to ascertain why Aetna was not honoring our pre-certification. One representative told us it was because the invoice was made out to us rather than Miranda, a 2-year-old. Another told us it was because the invoice was not formatted correctly. We submitted three separate invoices to accommodate each set of unique and meticulous requests. All denied. A fresh representative told us it was they never received any claims, even though we were in possession of a denials of the claims. Rather than address the inconsistency, the representative hung up on us. We called back and spoke to the same representative who hung up on us again. Our health insurance is an employee benefit provided through a large corporation. We opted to involve a representative from the employer's Human Resources department on subsequent calls. The HR representative was able to conference in and hear first-hand what we were confronting. Suffice it to say, we were never hung up on again. Previous and parallel to this, Fox 5 (the New York City affiliate of Fox) learned of this web site. They contacted us to request an on-camera interview. They also interviewed one of Miranda's physical therapists and her pediatric neurologist in Manhattan. The convergence of these events prompted Aetna to re-open our case. We entered the rarefied air of a Corporate Level Appeal in which a team of specialists would review our appeal along with an advocate of our choice who is permitted to speak to the committee. Following a lengthy phone consultation, we engaged the services of Dr. Paul G. Harch, co-author of The Oxygen Revolution, to act as our proponent.

AETNA AGREES TO REIMBURSE

Miranda's Story Airs on Fox 5 New York

After several attempts, we were unable to ascertain why Aetna was not honoring our pre-certification. One representative told us it was because the invoice was made out to us rather than Miranda, a 2-year-old. Another told us it was because the invoice was not formatted correctly. We submitted three separate invoices to accommodate each set of unique and meticulous requests. All denied.

A fresh representative told us it was they never received any claims, even though we were in possession of a denials of the claims. Rather than address the inconsistency, the representative hung up on us. We called back and spoke to the same representative who hung up on us again.

Our health insurance is an employee benefit provided through a large corporation. We opted to involve a representative from the employer's Human Resources department on subsequent calls. The HR representative was able to conference in and hear first-hand what we were confronting. Suffice it to say, we were never hung up on again.

Previous and parallel to this, Fox 5 (the New York City affiliate of Fox) learned of this web site. They contacted us to request an on-camera interview. They also interviewed one of Miranda's physical therapists and her pediatric neurologist in Manhattan.

The convergence of these events prompted Aetna to re-open our case. We entered the rarefied air of a Corporate Level Appeal in which a team of specialists would review our appeal along with an advocate of our choice who is permitted to speak to the committee. Following a lengthy phone consultation, we engaged the services of Dr. Paul G. Harch, co-author of The Oxygen Revolution, to act as our proponent.

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

Aetna makes a point to state their decision is not based on the quality of our appeal and should not be considered a precedent.

While we were being reimbursed for past claims, an upcoming Corporate Level Appeal would now serve the purpose of determining future coverage for Miranda.

One important note: While bitterness and frustration occasionally seeps from the pores of this site, I would like to make clear that not every employee of Aetna sprouts horns and carries a pitchfork. A majority of the representatives are friendly, supportive and eager to help. We understand they are often hamstrung by lawyers, corporate executives and the elaborate and impenetrable machinations of a major corporation whose profit motive would appear at cross-purposes with its enterprise. Our complaint is with the bureaucracy, not any one individual. And to those representatives, managers and executives who were forthcoming and extremely helpful -- if you're reading this -- we would like to extend our sincere appreciation.

We also owe a debt of gratitude to the doctors and therapists who supported us through Miranda's first three years of life, and stuck their necks out for Miranda and our cause.

Click here to learn more about Dr. Harch.

Click the book to jump to its Amazon page.

We anticipated several weeks before the Committee hearing would be scheduled. Unexpectedly, on the evening of Friday, November 6, 2009 -- one business day before the airing of the Fox 5 news segment -- Aetna verbally agreed to pay for all our prior HBOT treatments and faxed us a letter in confirmation.

Aetna's decision, not coincidentally, came on the eve of this news segment's broadcast:

Apparently, this whole thing was merely a clerical error.

Aetna Corporate Review Denies Coverage