I am not sure I should post this here....but....
I had Aetna deny OATS procedure stating that any osteochondral lesion larger than 1 cm is considered experimental. The lesion my doc repaired was about 3 cm.
I can find no information on this. Is a payor allowed to just deem something experimental? It has a CPT code, which has to be approved by the AMA, AHA, FDA, aunties, uncles, cats, dogs ect...............
Anyone had this problem?? How do I fight it?
I had Aetna deny OATS procedure stating that any osteochondral lesion larger than 1 cm is considered experimental. The lesion my doc repaired was about 3 cm.
I can find no information on this. Is a payor allowed to just deem something experimental? It has a CPT code, which has to be approved by the AMA, AHA, FDA, aunties, uncles, cats, dogs ect...............
Anyone had this problem?? How do I fight it?