Re: ann - Cigna's 100%

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To be honest I dont know...I do know that we are on the PPO and the contract amout for in network is 90% and out of network is 80%. So basically sent the lady an e-mail telling her that 70% was unacceptable and asked her if I needed to continue w/Level 2 appeal or is this where my attorney needed to step in. I also told her I felt Cigna Owed me the 100% for all of their inconsistancies and that if they would have approved it from the beginning I wouldnt have had to spend countless hours on the internet and preparing and that took away from my time with my kids...I also threw in the fact that since all of this has been going on my Lupus has been flaring and my Liver enzymes have had to be checked 4 times in two weeks, that the only time things like this happed seem to be when I get overly stressed. Thank God she was a mother and said she agreed w/me and she would have done the same. OH I also told them I knew of 4 other famlies that have had it all covered from 90-100% ..... which all is true....Trisha

ann Breslow <smilemtb@...> wrote: Trisha, you are very lucky! I'm very happy for you. But what I'd like to knowis how did you manage to get them to pay 100% when your contract is 70%payment (which means you pay a coinsurance of 30%)?? I'm really baffledby this. No ins co that I know of will ever pay 100% if the contracted rate isless, unless you met your out-of-pocket expenses. Please share!!ann/NJDOCband 3 weeks 2 days> Message: 5> Date: Fri, 19 Jul 2002 07:31:46 -0700 (PDT)> From: Trisha <ttm41@...>> Subject: ~!~!~!~!~ CIGNA PAID 100%~!~!~!~!~!~>> I just got this letter from Cigna on my e-mail :>> Trisha, I have adjusted your claim and made payment at 100%. Payment has been issued to Jon s. Payment amount is $3000.00. The coinsurance is the amount due by you after payment of 70% is made, so that means if I would of left payment at 70% then you would have been responsible for the 30% not covered that would have been your coinsurance. If you still do not understand please call me and I will do my best to explain. Please, don't worry about the way you came across, as a mother I totally understand, I would do the same for my son. Good luck to you and Braeden. If you have any more questions please do not hesitate to contact me.>> Thank you,>>For more plagio info