Thursday, September 11, 2008

Score Another One for the Little Guy

Based on our review of the above information, we are reversing our previous benefit decision and will now allow coverage for 56 hours of registered nursing services per week, and 60 hours of licensed practical nursing services per month supervised by an RN.*

Love, your friends at
(well, I added this part :-)


I just love it when David beats Goliath. Lesson learned: never give up and never give in. If you are entitled to it and if it's important to you - fight for it. Sometimes the little guy really does win.

*We are actually only getting 10 hrs/week of RN nursing and the balance of the hours are covered by an LPN (Kristi).

**Update: Of course, the wording in the letter from Aetna is causing heartburn for the nursing agency because our primary nurse is not an RN. So,while nursing has been approved, issues remain. I'll tackle them Monday.

Melisande - thanks for sending me all your information. It got the job done!


When the world says, "Give up",
Hope whispers, "Try it one more time"
~Author Unknown


"With ordinary talent and extraordinary perseverance,
all things are attainable"
~Thomas Foxwell Buxton



Melisande said...

Awesome, Ann! YOU ROCK!

julie w said...

Great job Ann! One in the eye for aetna ;)

Anonymous said...

You go girl! This just proves my adage "Look insurance company you can just approve this right now or we can fight for six months and then you can approve it. You figure out which is more cost-efficient and less painful for you!" Never give up, never give in!

Congrats on a fight well fought!

Anonymous said...

Great job Ann. It is a shame though that you have to expel that much energy on crap like that. You need it for other things.

Faith said...

Wow! I am impressed! Great Job! Now that you are the expert do you think we can do this as well? Kasier is our primary and of course they don't cover nursing. We have had the WORST luck with nurses and finally found a great one- however she told us this week (after me taking of 3 weeks to train her!) that she has applied for a job at the hospital b/c it pays better. Half the battle with getting and retaining good nurses is the pay- and as you know Medicaid doesn't not compensate very well (and our agency, PSA takes a big chunk..) So now you've got me thinking...perhaps if Kaiser covered the nursing they would pay more. Do you know the rate Aetna is going to pay your nurses?
As always thanks for the light bulb!
Jen & Co :)

Christy said...

I have a friend that wants to make a reality show - the insurance guy who stamps "denied" on the claim has to go and live in that family's shoes for a couple of days. Wouldn't that be fun to watch?!

Way to go, Ann!

Dana said...

Yea Ann! I could never have fought the insurance company. That's a hard fight. Keep fighting the good fight these kids deserve it. Way to go!! You give the rest of us hope.

Anonymous said...

Woohooo! That is great, Ann.