Re: Re: Need articles for my appeal

[Guest guest]

,

I am so frustrated that I have to prove to Cigna

that they should have to do what we pay them premuims

every month to do!! I have been writing my appeal

letter all day and am a little grumpy, sorry. Cigna

denied the DOC band for Ethan because " there was no

evidence of synostosis and because the requested

services did not meet the definition of medical

necessity found in our benefit plan " . I am not sure

why the first reason is even valid. I guess they

would rather pay hundreds of thousands of dollars and

put a six month old through surgery rather than pay

for a band. The doctors diagnosis was positional

plagiocephaly. Go figure??? The second reason is

fancy jargon for the cosmetic trump card. I am really

hoping that the medical review boards can see how

ridculous these reasons are and allow/pay for the

band. Let me know what you find out along the way.

One of these days Cigna needs to realize that there

are alot of kids out there needing this treatment and

will stop fighting. We can hope can't we??

--- gabbysmom85024 <dlicano@...> wrote:

> -

> Hi , I found most of my articles here but

> also did a

> plagiocephaly search and found a few others. Make

> sure you have the

> letter stating it is medically necessary! Also i

> just faxed my appeal

> to cigna with a letter from the doctor requesting a

> expedited review

> and they told us the treatment is not considered

> life threatning and

> they will respond in 30 days I told the person I

> talked to that

> since they did not think permanent hdamage to my

> daughter's head was

> important to hurry,they could expect to pay for two

> bands because of

> my daughter's age.why did Cigna deny you? They

> denied us saying no

> documentation of conservative medical therapy and no

> documentation of

> a Functional abnormality!Just curious what your

> denial letter said.

> Good Luck with yours!!!!!

> & la

> -- In Plagiocephaly@y..., Vanderpool

> <vanderpooljen@y...>

> wrote:

> > I need some help. I am in the process of writing

> my

> > appeals letter to Cigna and I am looking for some

> > convincing articles that support the use of the

> DOC

> > band. I am also trying to find the AMA document

> that

> > states that plagiocephaly is not a cosmetic fix.

> I

> > have looked on plagiocephaly.com web site and at

> > Cranial Tech. page and I need some more info. My

> > appeal letter needs to be faxed by Monday because

> they

> > are doing an urgent review on Ethan's case. Any

> and

> > all help is greatly appreciated. Thanks.

> > Vanderpool

> >

> > __________________________________________________

> >