Re: Gail - External Review Info

[Guest guest]

,

Thanks for the info - it is very helpful. I think I have decided to go with

MCMC for the external review. I know for sure that they have overturned at

least one Cigna denial, and that person gave me permission to use their name

in my next letter.

An interesting thing happened today. I got feisty on the phone with Cigna

last Monday and demanded that they send me the documentation that they based

their denial on. You'd think they would have had the courtesy to send it in

the first place. It arrived today. One of the articles was written by a

BCBS technology assessment panel and it basically said that the evidence of

long term health benefits from banding is inconclusive. I read it several

times to make sure I understood correctly, but they even underlined the

parts that they felt were important. Well, if " inconclusive " is the best

they can offer, then I just need to cross-reference the huge stack of

documentation that IS conclusive that I've already submitted and let them

take it from there. The other article was written by Tim Littlefield and

talked about how the bands redirect skull growth and can correct facial

assymetry. I think that they figured that would count towards the

" cosmetic " argument, but I'll just point them to the documentation about

facial assymetry and jaw misalignment that I've already submitted. It all

seems logical to me, but Cigna is not a logical company. ho hum. We'll see

what happens.

Thanks for the support,

Gail, Sam and Sara's mom, DOC grads

Gail - External Review Info

> Hi Gail,

>

> Sorry it's taken me so long to back to you. I reviewed by appeal

> paperwork and the external review board that handled my appeal is

> Peer Review Analysis and they're a division of CORE, INC. It says on

> their cover letter that they're URAC acredited and there's a website

> urac.org listed. My case was sent to them with my first appeal. I

> sent my appeal letter on May 18 and they external board sent me a

> letter on June 4th idicating that they received my paperwork and

> would make a decision in 5 business days. They mailed me their

> decision letter on May 11 stating they overturned BCBS' denial.

> Conveniently, BCBS had problems cutting my refund check and I just

> picked it up from CT today. BCBS mailed it to them a week ago. I

> hope this answers your questions. Again, I wish you the best of luck.

>

> , 's mom

> Southern California

>

>

> For more plagio info

[Guest guest]

you go Gail best of luck sound slike you have a good argument there!

beck