Wiki Please help..... SI RFA and Genicular RFA Medicare Advantage plans

[gmlynn2008@gmail.com]

I am having a lot of issues from Aetna Medicare not covering the 64451, 64454, 64624 and 64625, stating that these codes are experimental and investigational. However they are a payable and covered code for Medicare. I was under the impression that if it is a covered code by Medicare that the Advantage plan was supposed to cover it as well. Can you offer me some insight or guidance on how to fight these claims?

 

[mccoyheather]

You must review the MA policy guidelines per MA plan. Advantage plans do not "blindly" cover everything MCR approves. Call the MA plan and get the policy coverage determinations. BTW also check Medsoultions policy guidelines might also be utilized by AET. Insurance is just like buying a car you get what you pay for, not all models cost the same, what bells and whistles did you upgrade, and powered by gas or hybrid? Good idea to to verify policy regulations before all procedures.