Re: Cigna denying speech therapy claims

[Guest guest]

Hi !

You mentioned St. Barnabas so I assume you live in New Jersey somewhere near

me. At any rate, I have had some success with my insurance company by

writing to State of New Jersey Department of Banking and Insurance

Enforcement/Consumer Protection PO Box 329 Trenton, NJ 08625-0329 Tel:

(609) 292-5316. Tell them you wish to file a complaint and they will send

you the appropriate forms. It may seem like a lot of trouble, but

ultimately, it seems to work.

Judi mom to Gordon, 5 1/2, w/ hypotonia, dispraxia (severe motor planning

issues), sensory integration dysfunction and Noah, 2, with hypotonia,

sensory issues and speech delay.

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From: " highhopessrc " <scurto@...>

Subject: [ ] Cigna denying speech therapy claims

Date: Sun, Mar 31, 2002, 9:57 PM

due to " not appearing to be medically necessary.' ie has gOne

throught months of Speech from June until now. They will not pay all

of a sudden!! They have paid for all of St. Barnabas's sessions in the

past. I have sent evals. from Dr. Agin and more recent ones from our

therapist. ie has Hydrocephalus, Hypotonia, Oral Apraxia (severe)

and so on....... They have been sending us statements saying that this

was all in review. Now the most recent letter is a big NO! Where do I

go from here??? We are only getting private therapy on Saturdays now

but what about all of the past sessions that cost, putting it mildly,

A LOT? Any input would be greatly appreciated. Thanks!

[Guest guest]

Hi , I also had no's from Cigna until I insisted that the Cignia Medical

Director who is a physician review my reports and make the decision. Do you

know if the med. director already made the decision? Also, after that, you

can file an internal appeal within Cigna and I have been told by Cigna

themselves that speech has been approved many times at that level. Carolyn

[Guest guest]

Hi, I live in New Jersey, I saw your post. I have Health Net, and they

denied my son's speech therapy as well, I went through the 2-3 appeals in

Health Net. Then I contacted the New Jersey Division of Health and Senior

services for a stage 3 independent appeal which was through IPRO. I wrote

my own letters stating the medical neces. and I had the Neuro. and Speech

Ther. and his Primary care doctor reports. I won 30 sessions a year. Not

great but better than nothing. IPRO stated that Oral/Verbal Apraxia was not

a disease or chronic disability, but cound be helped with the proper

treatment. Any questions feel free to contact. Kathy

[Guest guest]

The American Speech and Hearing Association recently had an article

called " Getting Health Plans to Pay for Pediatric Verbal Apraxia "

I don't believe it is available on-line for members but if you know

an SLP who is a member then perhaps they can get it for you.

There is a number at the end of the article 800-498-2071 X4194 which

is the Action Center.

> due to " not appearing to be medically necessary.' ie has gOne

> throught months of Speech from June until now. They will not pay all

> of a sudden!! They have paid for all of St. Barnabas's sessions in

the

> past. I have sent evals. from Dr. Agin and more recent ones from our

> therapist. ie has Hydrocephalus, Hypotonia, Oral Apraxia

(severe)

> and so on....... They have been sending us statements saying that

this

> was all in review. Now the most recent letter is a big NO! Where do

I

> go from here??? We are only getting private therapy on Saturdays now

> but what about all of the past sessions that cost, putting it

mildly,

> A LOT? Any input would be greatly appreciated. Thanks!

[Guest guest]

:

Get your job involved. Talk to the benefits coordinator at your job and

discuss this problem with that person. The benefit coordinator is the link

between you and the insurance company that can make a difference.....JOYA

[Guest guest]

Hi !

You have already received some excellent advice -you may also want to

explore some great advice from

http://www.noonansyndrome.org/insurance1.html I was once told

(confidentially) by a PhD about the " master policy " and to let all

parents know to ask to see that when denied. If the insurance

company tells you they don't know what you mean -ask to speak to a supervisor

and then say by law they need to show the master policy to you. This

link http://www.noonansyndrome.org/insurance1.html goes into this

and much more!

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