Steve,
I have another question same insurance company. With the guidelines they have in place for back pain- invasive procedures. Back in December we were advised that the policy for the facet injections would be changing and this would be implemented on 5/14/2010. But the clinical policy still shows that the policy became effective on 7/31/1995, however the change was implemented on 5/14/2010. So here is my question, a patient had a facet injection in September which counted as 3, as patient is allowed a total of 6 per each procedure. This is the first injection the patient had for a facet in 2010 and since the implementation date of 5/14/2010. The claim denied for experimental and investigational. I called Aetna in reference to this and was advised the patient has already had this procedure twice and this was the third therefore it was denied. When I requested to find out by whom she had the other 2 procedures done by I was advised of the dates of service for 2 claims billed by my office back in 2009. When I advised the represenative that this (new policy change) was implemented on 5/14/2010 I was told that the policy has been effective since 7/31/1995. I am quite confused by this, and not sure how to understand the policy and the change. Am I not reading something correct? HELP!!