Aetna Won't, Will Medicare?

[GraceUnderFire]

Well, first I went through months of appeals with Aetna regarding getting pudendal decompression surgery from Dr. Dellon. He was out of network and even though he was the closest doctor to me that did the surgery, they ran me around in circles. I got totally frustrated with them and went to Dr. Echenberg as they required. Even Dr. Echenberg said I need to have the pudendal decompression surgery and recommended Dr. Conway (an Aetna participating provider). Great, right? Well, apparently not. Now Aetna is denying based on the surgery being experimental. I am SO frustrated.

I am, unfortunately but gratefully, on Social Security Disability, but I do not have Medicare. Before I go down that road (since I signed something saying I did not want Medicare) I am wondering . . . has anyone had Medicare pay for their pudendal decompression surgery?

Thank you
Grace

[nyt]

Medicare will NOT pay for Dr. Dellon has he does not participate with Medicare. A physician has to have a Medicare number and they have to submit the claim for Medicare. My primary insurance has paid for the majority of my pudendal surgery with Dr. Hibner and I'm waiting to see if Medicare will pay the co-pays.

[Violet M]

Grace, I think there is too much literature published on the TG approach for it to be considered experimental. You should have a good chance at appealing it since Dr. C is now using the TG approach. There are some articles here: http://pudendalhope.org/node/23

Lots of people have had TG surgery paid for by medicare but like nyt said it would have to be the right doc.

[elija]

Sometimes it's scary to have Medicare choose your doctor for you. I get really nervous when I go to a doctor that I don't know. Copays can be really expensive, so I totally understand the need to switch docs if Medicare says so. I just wish short term medical insurance paid the full bill rather than a percentage of it.