Aetna – Denial

My father needs hip replacement. So my father is 62. He’s done construction his whole life and a few years back gave up his business to work for a company. He started getting chronic pain along his side. First doctor he went to suggested it was his spine. Spent a bunch of money on injections that didn’t do anything. Keep in mind for the remainder of this that my parents do not have money to spend. Eventually went to get another opinion and they explained it was his hip. His hip has completely deteriorated and there are bone spurs. Everything was set for a hip surgery in February but the insurance company (Aetna) denied it. Said he needed 6 weeks of physical therapy and doctor’s checkups.

Then the surgery was scheduled for March upon completion of what Aetna required. So he completed the physical therapy and check ups. Both the PT and surgeon said that PT won’t do anything and frequently appealed to Aetna. Aetna denied each time. So he continued to go to his check ups again racking up medical bills. When he finished the sessions, I never saw my parents so excited…. Until Aetna denied the surgery outright after doing exactly what they asked. They deemed it not a medical emergency. After that was denied, the next surgery was scheduled for this week (April 25th) because the doctor said it would get sorted. Which it did not.

My dad has since lost his job, his pain and limp are both getting much worse, and my parents financial situation is a disaster. Not to mention both of their mental healths are falling apart from this. If this is not a medical emergency, what is? My dad isn’t trying to scam the system, he just wants to fix his life and go back to work.

My parents have been calling Aetna almost everyday for weeks to get answers and get none. They get redirected to different departments and different call centers and some being outside the country. Basically get the run around. No one cares and they tell him something different every time.

We contacted the state agency. The guy said they can’t do anything because it’s not a medical emergency and that was Aetna’s policy. Again how is this not a medical emergency? Is my dad just supposed to not support himself and fully lose his ability to walk? He’s been paying to this insurance for a reason.

The last thing we are about the try is an external appeal. So I guess my question is, is there a quicker process ? We’ve wasted so much damn time and money on this situation. Should we seek legal help? Is there anything else that could possibly be successful? Just looking for some advice. Thank you

submitted by /u/nordiclupo
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