in January of 2018 I was denied coverage for a cervical arthroplasty on two levels due to lack of moderate spinal stenosis. in May of 2018 I had another MRI done that shows I now have moderate stenosis.
My neurosurgeon started a new pre-certification and low and behold I was denied for lack of moderate to severe stenosis! Clinical policy bulletin for my policy clearly states that cervical arthroplasty is covered for moderate, moderate to severe, or severe spinal stenosis. Aetna medical directors will do absolutely anything to deny procedures and not pay anything! Aetna's moral compass no longer exists.
It's about the bottom line and how much money they can save and how bad they can treat their patients.
I am currently still fighting in the appeals process and have contacted an attorney. I suggest anyone who has had a similar experience contact an attorney so Aetna pays dearly for all the crimes they commit against their subscribers.