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Oats knee

  1. #1
    Default Oats knee
    Medical Coding Books
    I am hoping someone can give me some help-my doc performed an open oats procedure on a pt who has Aetna insurance. Aenta has denied as experimental and will not pay. We are going to request a peer to peer and I would like to go in with as much ammo as humanly possible. Has anyone appealed this procedure and won? Any info I could find somewhere that would help me plead my case? Thanks so much for any and all help! Have a great day!

  2. #2
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    Quote Originally Posted by cpccpma View Post
    I am hoping someone can give me some help-my doc performed an open oats procedure on a pt who has Aetna insurance. Aenta has denied as experimental and will not pay. We are going to request a peer to peer and I would like to go in with as much ammo as humanly possible. Has anyone appealed this procedure and won? Any info I could find somewhere that would help me plead my case? Thanks so much for any and all help! Have a great day!
    Take the Aetna policy on OATS and follow the reasonings that they give that would make it MEDICALLY NECESSARY and start there. Your doc will probably have to write a letter of medical necessity. It can be very diffucult. Go to the website:

    www.aetna.com/cpb/medical/data/600_699/0637.html.

    Let me know if you can't fins and I'll send it to you. Good luck!
    Keith

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