Aetna Health Insurance has denied me part of my surgery needed to correct underdeveloped upper and lower jaw, non-union of jawbone, misaligned jaws, obstructed airway at 4mm, Limited ROM at 12mm. They stated the reason for denial was cosmetic despite the fact that world renowned Dr. Larry Wolford has stated that I have a 4mm Maxillary Transverse Deficiency which falls under their guidelines and have to cover the surgery. He also sent in tracings to show I have a 4mm obstructed airway (11mm is normal). I found out from Aetna that none of my appeals had a review panel or committee hearing. I also found out that the original doctor involved in my precertification has on his website that maxillofacial surgery to correct deformities and birth defects is cosmetic which I feel is unfair for Aetna to use a doctor who already feels jaw surgeries to correct skeletal defects is considered cosmetic. I also found out that the other two doctors involved on my first and second appeal were both retired with one being retired over 10 years ago. The nurse on my appeal was a practical nurse who was not even a registered nurse with more experience. On these grounds I feel I have been given an unfair review and Aetna doctors have failed to take into account that I had six letters from doctors stating the medical necessity of my jaw surgeries. The letters even stated my obstructed airway could be life threatening. The non-union of jawbone could cause me to eventually lose part of my jaw if not corrected. Aetna stated that Orthdontics could correct my problem and made this statement with no Orthodontist on the panel. I am in my third set of braces and my Orthodontist sent Aetna a letter stating that he could not correct my occlusion until I have the jaw surgeries.
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