Hey all, I've recently had my provider request a gap exception for an upcoming procedure. He was given prior authorization to perform the procedure at my OON benefit level.
Aetna denied the network deficiency request, stating they have an in network provider. However, their only suggested provider is out of state and hundreds of miles away from my home.
I live in Los Angeles, and it boggles my mind that the only person they found was not only out of the city but out of state too. The requested procedure is incredibly common and I at least expected them to come up with someone closer.
With all that being said, would filing an appeal based on the distance of the suggested provider be acceptable? I would be wholly unable to drive back and forth multiple times to see them, especially after the procedure is done. My requested provider is less than 50 miles away from home and would actually be doable.