Guest guest Posted May 29, 2002 Report Share Posted May 29, 2002 In a message dated 5/29/2002 9:56:49 AM Central Daylight Time, trisham@... writes: 20!!! I said HELLO...I never even got a denial letter so I don't even know what grounds I would be appealing on .... and I asked them to fax me the denial letter again they said 72hours...then I asked for a copy of the letter they said I sent and she said it was confidential!!! sorry I'm not yelling at you I am CONFIDENTIAL HELLO aren't they claiming you are the one that sent it? How stupid is that?????????????????? Beck Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2002 Report Share Posted May 29, 2002 Oh Trisha, I have felt the same emotions that you are feeling. I dreamt about this all night long, and needless to say, I have a pounding headache this morning. They totally disregarded every argument we made in our appeal as if we didn't make any arguments at all, and they said the studies we presented we good but not sufficient. They said, "Though the data from Cranial Technologies may have been sufficient for the FDA"...it was not sufficient for CIGNA's Technology Assessment Council. What the...? On the cosmetic issue, they mentioned some pediatric journal, but they failed to give us the reference, like they are afraid we might find out something else from it. My hubby called Cook Childrens this morning and they are hunting for it. I know the head pathologist over there (I worked for him when we lived in Seattle), so I'm sure he can help us find the journal if we need it. And just in case, my hubby has been talking with an attorney in Dallas (he actually contacted us first) and he is giving us some advise on our next appeal. I guess his wife's friend, or friend's wife, got him interested in the problem with insurance companies denying DOC band coverage, and it looks like he might be joining the crusade. I'll keep you posted on what we do next, and we definitely want to meet up with you in person really soon. We can drive down there and meet you for lunch if you can get away. Gail P.S. Braeden is sooooo cute in his band!!! Gail Gail, Don't you just want to freaking SCREAM!!! I called Cigna this morning about the letter I got and they said I sent them a letter about appealing on 5/20!!! I said HELLO...I never even got a denial letter so I don't even know what grounds I would be appealing on .... and I asked them to fax me the denial letter again they said 72hours...then I asked for a copy of the letter they said I sent and she said it was confidential!!! sorry I'm not yelling at you I am just so frustrated.... What time were you at CT yesterday..??? we were there at 8:45 am and at 1:45pm....I would have loved to have met you in person.... Ok...about your stuff 1. what do they mean the AMA is incorrect who made Cigna's definitions correct....I think the AMA is quite a bit above them...that's just flat out wrong of them. 2. Is it not documented by the FDA that these bands are NOT experimental?? there is no way this can hold up...I think I may have printed some material on this.... 3. Sooooo they don't agree w/their OWN networked drs? the drs. they pay??? PPPUUUHLLLLLLEEEEEEAAAASSSSSEEEEE All I have to say is "lets kick some serious Cigna Ass"!!!! sorry for my verbiage but this just infuriates me... Have you mentioned to them that you know people that Cigna has paid these claims on ??? Grievance coordinator...they will need more than that...and if they want an escalated case give it to them.... You know if you ever want to get together and go over all of our ammo that we have and share....and help each other w/ideas I'd be willing...and another thing...I was going to as if you would send a e-mail to fox 4 asking about doing a story...maybe if they here it from more than one mom it will but a little fire under them.. Sorry to sound so hostile I just hate the fact they think they are GODS!!.. I am really a nice person... Hugs, Trisha -----Original Message-----From: Gail [mailto:momofivftwins@...]Sent: Tuesday, May 28, 2002 9:57 PMPlagiocephaly Subject: Cigna denied us - AGAIN! I just read Trisha's last post, and about all I can do right now is laugh (not at you, Trisha - at the imbeciles at Cigna). Cigna is messing with some tough Texans!!! We just received our next denial letter and I'm pretty angry about it, though not at all surprised. I think the medical director got his license from a grab bag at Sears! Anyway, let me paraphrase their most recent reasons for denial, and I'm not being sarcastic at all. 1. The AMA is incorrect in their definitions of cosmetic vs. reconstructive. 2. The FDA's classification of the DOC band as a category II neurology device is not valid and DOC bands are experimental. 3. The prescription for DOC banding by a participating physician who considers treatment medically necessary "does not de facto determine" medical necessity (only when convenient for Cigna). Did I miss something? Is today April Fools Day? They "regret that this response is not more favorable". They don't know the meaning of "regret" yet! I sure hope I'm beginning to sound like you, Trisha. They'll regret the day they ever denied payment. Here's another gripe...I have requested many times that they assign a grievance coordinator or customer advocate to us so that we can actually talk to someone that might know something about the appeals process, but they won't do it. They keep telling me that they save that for escalated issues. When does an issue become escalated? They tell us that we should call the member services phone number listed on our insurance card and they "will be happy to assist" us. Those people don't have a clue and they can't even transfer the call to someone in appeals. All they can do is put a note in the computer that we called looking for information. They are more classified than the FBI! Things just don't make sense. This is the same insurance company that reimbursed us $10,000 for in vitro fertilization and sent a huge packet of information to me about how to have healthy babies, yet they failed to mention that carrying twins full term could cause in utero constraint that leads to tort and plagio, and they definitely don't want to pay to correct the problem in these miracle babies. It makes me sad that such ignorant people can have such a strong influence on medical decisions for our precious little ones. Well, I've rambled on enough and I need to refocus my energy on the next appeal. I'll keep you posted. Gail, Sam and Sara (DOC grads) P.S. Sam had his exit cast today and he was awesome!For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2002 Report Share Posted May 29, 2002 Gail if you want to give the attorney my name feel free...I am considering an attorney my self and it might be a good thing if the same guy took us both...I cant talk much at the moment....I am swamped at work and I have to actually try to work today since yesterday was shot...Hugs and lets kick their butts... BTW...CT gave me a ton of brochures on stuff if you want copies LMK.. Trisha Thanks I kind of think hes cute too...he's my little booboo -----Original Message-----From: Gail [mailto:momofivftwins@...]Sent: Wednesday, May 29, 2002 10:20 AMPlagiocephaly Subject: Re: Gail Oh Trisha, I have felt the same emotions that you are feeling. I dreamt about this all night long, and needless to say, I have a pounding headache this morning. They totally disregarded every argument we made in our appeal as if we didn't make any arguments at all, and they said the studies we presented we good but not sufficient. They said, "Though the data from Cranial Technologies may have been sufficient for the FDA"...it was not sufficient for CIGNA's Technology Assessment Council. What the...? On the cosmetic issue, they mentioned some pediatric journal, but they failed to give us the reference, like they are afraid we might find out something else from it. My hubby called Cook Childrens this morning and they are hunting for it. I know the head pathologist over there (I worked for him when we lived in Seattle), so I'm sure he can help us find the journal if we need it. And just in case, my hubby has been talking with an attorney in Dallas (he actually contacted us first) and he is giving us some advise on our next appeal. I guess his wife's friend, or friend's wife, got him interested in the problem with insurance companies denying DOC band coverage, and it looks like he might be joining the crusade. I'll keep you posted on what we do next, and we definitely want to meet up with you in person really soon. We can drive down there and meet you for lunch if you can get away. Gail P.S. Braeden is sooooo cute in his band!!! Gail Gail, Don't you just want to freaking SCREAM!!! I called Cigna this morning about the letter I got and they said I sent them a letter about appealing on 5/20!!! I said HELLO...I never even got a denial letter so I don't even know what grounds I would be appealing on .... and I asked them to fax me the denial letter again they said 72hours...then I asked for a copy of the letter they said I sent and she said it was confidential!!! sorry I'm not yelling at you I am just so frustrated.... What time were you at CT yesterday..??? we were there at 8:45 am and at 1:45pm....I would have loved to have met you in person.... Ok...about your stuff 1. what do they mean the AMA is incorrect who made Cigna's definitions correct....I think the AMA is quite a bit above them...that's just flat out wrong of them. 2. Is it not documented by the FDA that these bands are NOT experimental?? there is no way this can hold up...I think I may have printed some material on this.... 3. Sooooo they don't agree w/their OWN networked drs? the drs. they pay??? PPPUUUHLLLLLLEEEEEEAAAASSSSSEEEEE All I have to say is "lets kick some serious Cigna Ass"!!!! sorry for my verbiage but this just infuriates me... Have you mentioned to them that you know people that Cigna has paid these claims on ??? Grievance coordinator...they will need more than that...and if they want an escalated case give it to them.... You know if you ever want to get together and go over all of our ammo that we have and share....and help each other w/ideas I'd be willing...and another thing...I was going to as if you would send a e-mail to fox 4 asking about doing a story...maybe if they here it from more than one mom it will but a little fire under them.. Sorry to sound so hostile I just hate the fact they think they are GODS!!.. I am really a nice person... Hugs, Trisha -----Original Message-----From: Gail [mailto:momofivftwins@...]Sent: Tuesday, May 28, 2002 9:57 PMPlagiocephaly Subject: Cigna denied us - AGAIN! I just read Trisha's last post, and about all I can do right now is laugh (not at you, Trisha - at the imbeciles at Cigna). Cigna is messing with some tough Texans!!! We just received our next denial letter and I'm pretty angry about it, though not at all surprised. I think the medical director got his license from a grab bag at Sears! Anyway, let me paraphrase their most recent reasons for denial, and I'm not being sarcastic at all. 1. The AMA is incorrect in their definitions of cosmetic vs. reconstructive. 2. The FDA's classification of the DOC band as a category II neurology device is not valid and DOC bands are experimental. 3. The prescription for DOC banding by a participating physician who considers treatment medically necessary "does not de facto determine" medical necessity (only when convenient for Cigna). Did I miss something? Is today April Fools Day? They "regret that this response is not more favorable". They don't know the meaning of "regret" yet! I sure hope I'm beginning to sound like you, Trisha. They'll regret the day they ever denied payment. Here's another gripe...I have requested many times that they assign a grievance coordinator or customer advocate to us so that we can actually talk to someone that might know something about the appeals process, but they won't do it. They keep telling me that they save that for escalated issues. When does an issue become escalated? They tell us that we should call the member services phone number listed on our insurance card and they "will be happy to assist" us. Those people don't have a clue and they can't even transfer the call to someone in appeals. All they can do is put a note in the computer that we called looking for information. They are more classified than the FBI! Things just don't make sense. This is the same insurance company that reimbursed us $10,000 for in vitro fertilization and sent a huge packet of information to me about how to have healthy babies, yet they failed to mention that carrying twins full term could cause in utero constraint that leads to tort and plagio, and they definitely don't want to pay to correct the problem in these miracle babies. It makes me sad that such ignorant people can have such a strong influence on medical decisions for our precious little ones. Well, I've rambled on enough and I need to refocus my energy on the next appeal. I'll keep you posted. Gail, Sam and Sara (DOC grads) P.S. Sam had his exit cast today and he was awesome!For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2002 Report Share Posted May 29, 2002 My thoughts exactly....I cant believe them.... -----Original Message-----From: bbbhand@... [mailto:bbbhand@...]Sent: Wednesday, May 29, 2002 2:13 PMPlagiocephaly Subject: Re: GailIn a message dated 5/29/2002 9:56:49 AM Central Daylight Time, trisham@... writes: 20!!! I said HELLO...I never even got a denial letter so I don't even know what grounds I would be appealing on .... and I asked them to fax me the denial letter again they said 72hours...then I asked for a copy of the letter they said I sent and she said it was confidential!!! sorry I'm not yelling at you I am CONFIDENTIAL HELLO aren't they claiming you are the one that sent it? How stupid is that??????????????????Beck For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 , Thanks. That's a great definition. I spent an hour last night looking at online medical dictionaries for definitions of EVERYTHING I'm arguing, but I think you found a better one. Thanks for the help. Gail Gail In a message dated 6/12/2002 10:10:48 AM Eastern Daylight Time, momofivftwins@... writes: "to treat a condition, including a birth defect". If I can prove that Sam and Sara's plagio and tort began in utero, would it be considered a birth defect? Any thoughts?Gail,I would think this would be a good angle- here's the American Heritage College Dictionary's interpretation of birth defect: any physiological or structural abnormality present at or before birth, especially as a result of faulty development, infection, hereditary or injury. So I would think that the fact that the skull was not able to grow normally as it was cramped, would be considered a birth defect. Now, add torticollis to that, and I think that's a winner!!! The muscle was not allowed to grow normally as well so...........Now only to convince the insurance companies Good luck and go get 'em!' MomFor more plagio info Quote Link to comment Share on other sites More sharing options...
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