Re: Cigna: round 3 (or is it 4?)

[Guest guest]

Hi Gail,

First of all you're not pitiful, the insurance co's

are! I can't answer your three questions. But, now

that it's out of Cigna's hands I think you really have

a great chance of getting this thing overturned. My

insurance, BCBS of Oregon referred my claim to an

external review board with my first appeal and that

board overturned the denial saying that the band was

medically necessary and BCBS paid 100% for the DOC

Band and treatment. I also remember somebody in this

group posting that alot of other parents have had

their denials overturned by external review boards.

I'm rooting for you!

, 's mom

Southern California

--- Gail <momofivftwins@...> wrote:

> Ah, there's nothing like returning home from a nice

> family vacation only to find another DENIAL letter

> from CIGNA. AAAARRRGH!!! I am totally dumbfounded

> and disheartened! First I need to vent, then I have

> some questions for ya'll...

>

> " The Appeals Committee contained a physician who

> specialized in Internal Medicine. " Uh, what does

> this have to do with my case and why would I want an

> internist making decisions about my baby's heads?!

>

> They are still rejecting the efficacy of DOC bands

> by vaguely referencing journals. Here's what they

> referenced: " controlled studies published in

> refereed medical journals " and " national reviews by

> several sources " . Why is it that I had to submit

> carefully documented references with my appeals, yet

> they can get away with this?!?!?!?!?!?

>

> I'm fuming...

>

> Now for my questions about external reviews...

>

> 1. Does anyone know anything about Plus in

> Philadelphia or Medical Care Management Corp. in

> Bethesda, land? These are the 2 independent

> reviewers that we have to choose from.

> 2. How long does an external review take?

> 3. How do independent review organizations make

> their money? I'm curious about this since Cigna is

> the one providing us the information about them.

>

> My husband is calling the attorney in the morning

> because he is sick of dealing with Cigna, so I want

> to hear from any of you who have gone through an

> external review to find out if it is quick enough

> for us to take the time to do it or if you would

> recommend handing it over to a lawyer at this point.

> (sorry about the run-on sentence). I'll definitely

> be calling " on behalf of the appeal

> committee " , but I know she won't do anything for me.

> It'll just make me feel better.

>

> Ok everyone, here's where I need all your kind words

> of support and encouragement. I'm sure I would have

> given up a long time ago if it weren't for the help

> you've given me, so please don't stop now. Am I

> pitiful or what!?

>

> Gail, Sam and Sara's mom, enraged Cigna crusader

>

__________________________________________________

[Guest guest]

Gail,

Wow! I can't believe they denied it again. Insurance companies are unbelievable...so uncaring. I know they are a business..but still..if it was one of their kids...they would be sure to get it covered.

Hang in there...keep fighting them. Hopefully when they see how persistant you are...they will give in. You are doing the right thing though!!

Keep us posted...and stay strong!!

In a message dated 7/28/2002 8:15:29 PM Pacific Daylight Time, momofivftwins@... writes:

Ok everyone, here's where I need all your kind words of support and encouragement. I'm sure I would have given up a long time ago if it weren't for the help you've given me, so please don't stop now. Am I pitiful or what!?

Gail, Sam and Sara's mom, enraged Cigna crusader

[Guest guest]

,

Thanks for the reply and words of encouragement. Do you know who the

external review board was? How long did they take to review your case? How

long after that did your insurance company issue payment? I know, lots of

questions.

Gail, Sam and Sara's mom, DOC grads

P.S. Have you always lived in So. Cal.? I knew a Andersen in N.

Cal when I was growing up - Los Altos area.

Re: Cigna: round 3 (or is it 4?)

> Hi Gail,

>

> First of all you're not pitiful, the insurance co's

> are! I can't answer your three questions. But, now

> that it's out of Cigna's hands I think you really have

> a great chance of getting this thing overturned. My

> insurance, BCBS of Oregon referred my claim to an

> external review board with my first appeal and that

> board overturned the denial saying that the band was

> medically necessary and BCBS paid 100% for the DOC

> Band and treatment. I also remember somebody in this

> group posting that alot of other parents have had

> their denials overturned by external review boards.

> I'm rooting for you!

>

> , 's mom

> Southern California

>

> --- Gail <momofivftwins@...> wrote:

> > Ah, there's nothing like returning home from a nice

> > family vacation only to find another DENIAL letter

> > from CIGNA. AAAARRRGH!!! I am totally dumbfounded

> > and disheartened! First I need to vent, then I have

> > some questions for ya'll...

> >

> > " The Appeals Committee contained a physician who

> > specialized in Internal Medicine. " Uh, what does

> > this have to do with my case and why would I want an

> > internist making decisions about my baby's heads?!

> >

> > They are still rejecting the efficacy of DOC bands

> > by vaguely referencing journals. Here's what they

> > referenced: " controlled studies published in

> > refereed medical journals " and " national reviews by

> > several sources " . Why is it that I had to submit

> > carefully documented references with my appeals, yet

> > they can get away with this?!?!?!?!?!?

> >

> > I'm fuming...

> >

> > Now for my questions about external reviews...

> >

> > 1. Does anyone know anything about Plus in

> > Philadelphia or Medical Care Management Corp. in

> > Bethesda, land? These are the 2 independent

> > reviewers that we have to choose from.

> > 2. How long does an external review take?

> > 3. How do independent review organizations make

> > their money? I'm curious about this since Cigna is

> > the one providing us the information about them.

> >

> > My husband is calling the attorney in the morning

> > because he is sick of dealing with Cigna, so I want

> > to hear from any of you who have gone through an

> > external review to find out if it is quick enough

> > for us to take the time to do it or if you would

> > recommend handing it over to a lawyer at this point.

> > (sorry about the run-on sentence). I'll definitely

> > be calling " on behalf of the appeal

> > committee " , but I know she won't do anything for me.

> > It'll just make me feel better.

> >

> > Ok everyone, here's where I need all your kind words

> > of support and encouragement. I'm sure I would have

> > given up a long time ago if it weren't for the help

> > you've given me, so please don't stop now. Am I

> > pitiful or what!?

> >

> > Gail, Sam and Sara's mom, enraged Cigna crusader

> >

>

>

> __________________________________________________

>

[Guest guest]

Gail,

I know I am a bit late in responding, but I wanted to share my experience. I

went through EXACTLY what you are going through. We didn't get a choice about

which review board to use. It was a randomly selected board as far as I

understood. I had to pay $50, but with the understanding that I would get

that money back if I won the review. I can't remember how long it took, but

it was probably about 1 1/2 months. It was worth it though and if I had not

won I would have pursued it in small claims court.

I'm sorry that Cigna is stupid. I think you will win the external review. My

external review board cited a national document of some sort and that coupled

with the letter of medical necessity from my specialist was what overturned

the decision.

Good luck with whatever you decide to do. I know how pissed and frustrated

you must be right now - I can remember how I felt and it sucked!!

Marci (mom to )

Oklahoma

[Guest guest]

Marci,

Thanks for replying. I knew you won on external review, so I was waiting to

hear from you. We don't have to pay anything for the review, but I do have

to hassle with it and write one more letter. I got a bit of good news

tonight. Do you remember - Owen's mom? She beat Cigna a few months

ago and was the reason I found and joined this group. I emailed her earlier

and she replied with some great information, including the fact that they

used MCMC for their external review, and that is one of our choices. There

it is - they overturned at least one denial for DOC band payment. That's

what I was looking for, and in the next few days I will be submitting the

paperwork and request to have them review our case.

I also want to share that I was inspired by Trisha and was able to " exchange

words " with someone at Cigna today. I even raised my voice a little. I

asked her a question about getting a name and number of a specific contact

and she replied by telling me to just call member services at the 1-800

number. That was the staw that broke this camels back and I told her that

that is unacceptable and I have documented every time that I have called

them and the left hand doesn't know what the right hand is doing and she

better get me a name soon! I've been calling member services about this

since February and have yet to get even one question answered. I told her I

needed information immediately as we are putting together our legal case

against Cigna (which is true because my husband contacted Bill Fynes today).

Now, tonight I'm feeling bad for being snippy with her, but they have NEVER

been nice to me, and turnabout's fair play!

(By the way, Trisha, I used your name today. I asked the lady at Cigna why

they paid for Braeden's band just last week when they told me they won't pay

for procedures that are experimental and unproven. There was silence on the

other end of the phone.) They're wrong and they know it.

More updates later...

Gail, Sam and Sara's mom, DOC grads

Re: Cigna: round 3 (or is it 4?)

> Gail,

>

> I know I am a bit late in responding, but I wanted to share my experience.

I

> went through EXACTLY what you are going through. We didn't get a choice

about

> which review board to use. It was a randomly selected board as far as I

> understood. I had to pay $50, but with the understanding that I would get

> that money back if I won the review. I can't remember how long it took,

but

> it was probably about 1 1/2 months. It was worth it though and if I had

not

> won I would have pursued it in small claims court.

>

> I'm sorry that Cigna is stupid. I think you will win the external review.

My

> external review board cited a national document of some sort and that

coupled

> with the letter of medical necessity from my specialist was what

overturned

> the decision.

>

> Good luck with whatever you decide to do. I know how pissed and frustrated

> you must be right now - I can remember how I felt and it sucked!!

>

> Marci (mom to )

> Oklahoma

>

>

> For more plagio info

[Guest guest]

Gail, You go girl! They don't have a chance against you. Best of luck Re: Cigna: round 3 (or is it 4?)> Gail,>> I know I am a bit late in responding, but I wanted to share my experience.I> went through EXACTLY what you are going through. We didn't get a choiceabout> which review board to use. It was a randomly selected board as far as I> understood. I had to pay $50, but with the understanding that I would get> that money back if I won the review. I can't remember how long it took,but> it was probably about 1 1/2 months. It was worth it though and if I hadnot> won I would have pursued it in small claims court.>> I'm sorry that Cigna is stupid. I think you will win the external review.My> external review board cited a national document of some sort and thatcoupled> with the letter of medical necessity from my specialist was whatoverturned> the decision.>> Good luck with whatever you decide to do. I know how pissed and frustrated> you must be right now - I can remember how I felt and it sucked!!>> Marci (mom to )> Oklahoma>>> For more plagio info

[Guest guest]

WOOHOO!

Go kick some cigna butt Gail!!

Give them hell!!

Good luck,

> Marci,

> Thanks for replying. I knew you won on external review, so I was

waiting to

> hear from you. We don't have to pay anything for the review, but I

do have

> to hassle with it and write one more letter. I got a bit of good

news

> tonight. Do you remember - Owen's mom? She beat Cigna a few

months

> ago and was the reason I found and joined this group. I emailed

her earlier

> and she replied with some great information, including the fact

that they

> used MCMC for their external review, and that is one of our

choices. There

> it is - they overturned at least one denial for DOC band payment.

That's

> what I was looking for, and in the next few days I will be

submitting the

> paperwork and request to have them review our case.

>

> I also want to share that I was inspired by Trisha and was able

to " exchange

> words " with someone at Cigna today. I even raised my voice a

little. I

> asked her a question about getting a name and number of a specific

contact

> and she replied by telling me to just call member services at the 1-

800

> number. That was the staw that broke this camels back and I told

her that

> that is unacceptable and I have documented every time that I have

called

> them and the left hand doesn't know what the right hand is doing

and she

> better get me a name soon! I've been calling member services about

this

> since February and have yet to get even one question answered. I

told her I

> needed information immediately as we are putting together our legal

case

> against Cigna (which is true because my husband contacted Bill

Fynes today).

> Now, tonight I'm feeling bad for being snippy with her, but they

have NEVER

> been nice to me, and turnabout's fair play!

>

> (By the way, Trisha, I used your name today. I asked the lady at

Cigna why

> they paid for Braeden's band just last week when they told me they

won't pay

> for procedures that are experimental and unproven. There was

silence on the

> other end of the phone.) They're wrong and they know it.

>

> More updates later...

>

> Gail, Sam and Sara's mom, DOC grads

>

> Re: Cigna: round 3 (or is it 4?)

>

>

> > Gail,

> >

> > I know I am a bit late in responding, but I wanted to share my

experience.

> I

> > went through EXACTLY what you are going through. We didn't get a

choice

> about

> > which review board to use. It was a randomly selected board as

far as I

> > understood. I had to pay $50, but with the understanding that I

would get

> > that money back if I won the review. I can't remember how long it

took,

> but

> > it was probably about 1 1/2 months. It was worth it though and if

I had

> not

> > won I would have pursued it in small claims court.

> >

> > I'm sorry that Cigna is stupid. I think you will win the external

review.

> My

> > external review board cited a national document of some sort and

that

> coupled

> > with the letter of medical necessity from my specialist was what

> overturned

> > the decision.

> >

> > Good luck with whatever you decide to do. I know how pissed and

frustrated

> > you must be right now - I can remember how I felt and it sucked!!

> >

> > Marci (mom to )

> > Oklahoma

> >

> >

> > For more plagio info