Aetna is an insurance company and provides no health care. Unfortunately Aetna is trying to dictate and make decisions for doctors. Only lawsuits will stop this from happening. If your doctor is recommending a treatment and Aetna denies coverage for that treatment and something goes wrong, then yes Aetna can and should be held liable, not your doctor.
People need to start lawyering up. It's not the doctor that is the problem, it is insurance.
I think that Mark Twain was suggesting you say nothing.
If your doctor recommends treatment and its not paid by insurance... you can still get the treatment... in the end you have a say...
Why pay someone else to make healthcare decisions for you? Why not just pay for them yourself and make your own decisions? Pool your premiums with a hundred other people and make your own plan. And in your plan take on new people without regard to pre existing diseased and morbidly obese because that would be against the law to discriminate, and also anyone poor who applies you must seek out to sign them up and make their premiums free.
Agreed with other's responses. You have to check your plan document and call the insurance company. Your doctor/hospital has no clue when it comes to coverage of any particular treatment. In fact, sometimes hospitals will avoid mentioning they are not in-network with the insurer or will flat out lie, so its best to check with insurance before you get treated. I've witnessed it. This isn't new, has been done for years-- that's what Managed Care is. By the way, if insurance is through your employer, depending on your plan type (self insured or fully insured), it may in some cases actually be your employer who has the final say whether or not something is covered. Don't believe me, then do a little research.
The last couple of years I've been seeing a huge number of specialists dropping to out of network. AET ties up to many office resources. The docs know it and it's easier for them to refuse to be in network. I really can't understand how a paper processor can offer anything of value to the healthcare system. I've noticed they've built a number of subsidiaries to approve or disapprove treatment and drag out the approval process much longer. Maybe the patient will die in the mean time.
haleakala, that's true - but there's more to it.
Insurance is a contract to pay, and the says what it will pay for, and what it won't. If you get treated for something your insurance won't pay for, it won't pay.
Trouble is, most people like "america_wants_change" believe insurance should pay for "everything" and STILL be "affordable". People like them are stuck in a dream they can't wake up from.