HR approach and strategy

[MK1965]

I am denied 3rd time for implant revision by my insurance (Aetna) which is employer sponsored. Reason for needing revision is pain, discomfort and implant malposition with sub clinical infection being very possible.
I was advised by my doc to approach HR directly and ask if any solution is available for cases like mine.
I feel very uncomfortable to talk about this at the company where I work.
Good thing is I work remotely about 1600 - 1700 miles away so my face is not well known to them.
I am determined to tackle this issue until some solution is available.
I am asking everyone with experience in talking to HR about this issue to point me in right direction with some good advice and strategy. Also, others with no direct experience can have some good advice to follow.
My doc also wrote me a very extensive latter about medical necessity for this procedure.
I appreciate all responses.
MK

[SteveSW]

MK, Many large companies (don't know how big your organization is) have a dedicated person(s) in either their HR or employee benefits departments who advocate for their employees. Start checking your companies structure, call the department that oversees insurance and ask if they have an advocate. You wouldn't need to give them any specifics at this point, just generalities of the situation. Keep fighting, the insurance companies often cave in and approve it, eventually. Good luck.

[Lost Sheep]

I am denied 3rd time for implant revision by my insurance (Aetna) which is employer sponsored. Reason for needing revision is pain, discomfort and implant malposition with sub clinical infection being very possible.
I was advised by my doc to approach HR directly and ask if any solution is available for cases like mine.
I feel very uncomfortable to talk about this at the company where I work.
Good thing is I work remotely about 1600 - 1700 miles away so my face is not well known to them.
I am determined to tackle this issue until some solution is available.
I am asking everyone with experience in talking to HR about this issue to point me in right direction with some good advice and strategy. Also, others with no direct experience can have some good advice to follow.
My doc also wrote me a very extensive latter about medical necessity for this procedure.
I appreciate all responses.
MK

This is advice I gave to a fellow U.S. Military Veteran using the V.A. medical care system. The same advice translates well to civilian insurance companies. Bureaucracies don't care where they were built.

Get your primary care physician (PCP) on board. He/She will be your most influential advocate. I spend a LONG time researching medical papers (even before finding Franktalk) and my PCP told me that I knew more about impotence and implants than he did. He took my information and clinical testimony to heart and as far as authorization is concerned, it was smooth sailing. Of course, I had a history of oral medications working and then failing, so I was able to make the case for skipping suppositories, injections and vacuum devices.

Referral to a urologist was easy - once I had my primary physician on my side. Lay that groundwork! As it was when you were in-service, take nothing for granted, do your homework and have your advance team (which consists of one member - YOU) prepare, make contacts and engage allies. I found my surgeon because I spoke to the VA's travel arranger (who at first was obstructive - I wanted to have the VA fly me across the country, but she said that was a no-go from the get-go). But I did not irritate her. Then one day, she told me that a urological surgeon had recently been assigned to Elmendorf AFB Hospital, and that he had TAUGHT the procedure. She didn't have to call and tell me that, but she helped me out in that way.

When you talk to folks. Take notes. Take down their names and every time you hang up, thank them by name, even if they were not helpful. They spent time with you and that is something to thank them for. And they remember. Get them on your side (or at least not oppositional). I am probably telling you stuff you already know, but it bears exposure for anyone who might read this thread.

Good luck.