Opinion ID: 6334161
Heading Depth: 2
Heading Rank: 4

Heading: Fisher’s Appeal Within Aetna

Text: In August 2014, Dunnegan and Warner contacted Aetna about its decisions concerning coverage of EffexorXR. Aetna informed them that if Fisher and her doctor submitted a medical-necessity waiver of the Choose Generic clause, Aetna may approve and cover EffexorXR retroactively. Dunnegan initially sent a fax to Fisher’s doctor, Dr. Rosenfeld, requesting he call Aetna, but just two days later, sent another fax instructing Dr. Rosenfeld to disregard the 12 previous one because “Aetna has no interest in making an honest interpretation of its policy and . . . talking to [Aetna] is a waste of time.” No. 20-3148, App’x at 416. Dunnegan, instead, submitted an appeal within Aetna on September 8, 2014. Aetna denied the appeal and instead of filing a second-level appeal, Fisher sued Aetna on behalf of herself and all others similarly situated.