Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Well, we had our level 2 appeal today with Cigna. We sat by the phone for an hour waiting for them to call. I was totally armed with my huge stack of documentation. The coordinator called, introduced the 3 people on the panel (who didn't bother to say anything) and told us to begin. We had no idea what they wanted, so I asked, and they told me to just tell them what I thought they needed to know about our case. Where do I begin?!?! Anyway, I gave them all the medical background and then my husband spent a few minutes addressing their denial reasons. This took about 10 minutes. We didn't want to talk too long and lose their interest. The coordinator says, " thank you. Does any of the panel members have any questions at this time? " There was a long pause and then we heard the one doctor on the panel say, " uuhhhh, no questions " . Was that Beavis or Butthead? I'm not sure. Then the coordinator says, " thank you, we'll vote on your case and notify you of the decision within 5 business days. Good bye " . And that was it. We have no idea if they even read the written information we submitted prior to this meeting or if any of them even had a pulse. So now we begin the waiting game. By this time next week we should know if we will get our $6000 back or if we get to keep fighting. I'm really ready for this to be over, so keep your fingers and toes crossed that I was able to wow them with my terminology and knowledge (thanks to all of you) and pursuade them to do the right thing! Gail, Sam and Sara's mom, DOC grads (for 2 months already!) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Gail, I sure hope you get the denial overturned. I'll keep my fingers and toes crossed for you! It sounds like you have done all you can at this point. Don't forget if this for some reason does not work you still have an external review coming your way. Best of luck!!! Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Thanks Marci, I HAVE done all I can at this point. The relief comes from knowing that I get a break for a while as there is nothing I can do until I hear back from Cigna. And I definitely haven't forgotten the external review or the possibility of using Bill Fynes (the attorney in Dallas who has taken up the cause for many already, including some advice for Trisha). I'm so ready for this to be done! I know that the appeals panel has already made a decision on our case, but they said that they would notify us within 5 business days. Would it hurt for them to just call and give us their decision? I can't take it. We're leaving town for the weekend. It's supposed to be 100 degrees in Dallas this weekend, so we're going to San (where it's probably hotter) to Sea World and to see the River Walk. The family needs a break and I need to get away from this computer for a while! Thanks for the good luck vibes. Gail Re: Let the waiting begin... > Gail, > > I sure hope you get the denial overturned. I'll keep my fingers and toes > crossed for you! It sounds like you have done all you can at this point. > Don't forget if this for some reason does not work you still have an external > review coming your way. > > Best of luck!!! > > Marci > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Gail, I really hope that Beavis (or was that Butthead!!! makes the right choice and reimburses you for this medical necessity!!!! Too bad it wasn't more like a question and answer format where they seemed eager to figure this all out- but maybe they are doing their homework (fingers crossed). Good luck all the way! ' Mom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Do you know any contact info for Bill Fynes? I am in the Houston area am looking into attorneys. My daughter was never treated because the pedi did not refer us until 13 months and then the neuro said the helmet would not help much at this age and was torture. I now know that she could have gotten correction at that age and I am mad that he did not prescribe the band. Thanks. > Thanks Marci, I HAVE done all I can at this point. The relief comes from > knowing that I get a break for a while as there is nothing I can do until I > hear back from Cigna. And I definitely haven't forgotten the external > review or the possibility of using Bill Fynes (the attorney in Dallas who > has taken up the cause for many already, including some advice for Trisha). > I'm so ready for this to be done! I know that the appeals panel has already > made a decision on our case, but they said that they would notify us within > 5 business days. Would it hurt for them to just call and give us their > decision? I can't take it. We're leaving town for the weekend. It's > supposed to be 100 degrees in Dallas this weekend, so we're going to San > (where it's probably hotter) to Sea World and to see the River Walk. > The family needs a break and I need to get away from this computer for a > while! Thanks for the good luck vibes. > > Gail > > > Re: Let the waiting begin... > > > > Gail, > > > > I sure hope you get the denial overturned. I'll keep my fingers and toes > > crossed for you! It sounds like you have done all you can at this point. > > Don't forget if this for some reason does not work you still have an > external > > review coming your way. > > > > Best of luck!!! > > > > Marci > > > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Gail, Enjoy the trip to San - you surely do deserve a break. Put this whole mess out of your mind and have a great time!!! Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 I really wish they had asked some questions. I would like to know if they read our appeal letters and if they even knew what plagio is before I explained it to them yesterday. I can only hope that the 2 women on the panel are moms and they can pursuade the doc to vote in my favor. I'll keep you posted... Gail Re: Let the waiting begin... > Gail, > I really hope that Beavis (or was that Butthead!!! makes the right choice > and reimburses you for this medical necessity!!!! Too bad it wasn't more > like a question and answer format where they seemed eager to figure this all > out- but maybe they are doing their homework (fingers crossed). Good luck > all the way! > > ' Mom > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
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