Re: We get another appeal!

[Guest guest]

Hi Gail,

I've appealed other insurance decisions and have found the following

tactics helpful:

1) Stick to the facts. As tempting as it is to point out how awful

Cigna is, keep in mind that - to someone who isn't familiar with the

situation and all you've gone through - this could be distracting and

make you appear unreasonable.

2) Bring in as much documentation as you can - but keep it straight

forward. Present letters from your doctors, Cranial Technologies,

etc that clearly state why the treatment was medically necessary.

Bring along any medical articles you can find - especially something

on the DOC Band being FDA approved and the standard of care for this

condition. By bringing all this evidence why this should be paid

for, you make it easier for the Committee to rule in your favor.

3) Find out how many people will be hearing the appeal (if possible),

and bring a copy of your presentation for each of them. It helps to

see things in front of them.

4) Don't be emotional. If you attack the insurance company, they

might get defensive (remember, they CHOSE Cigna as their insurance

carrier). You need to seem like YOU are the reasonable one here -

its fine to point out mistakes Cigna made (like mixing up the twins

and claiming falsely that your doctor has a financial interest in the

treatment), but be aware that none of those issues will make them

decide to pay for the treatment. And, harping on picky issues makes

it hard for them to see the big picture - your children had a

medically treatable problem which was corrected using an FDA approved

device - which your insurance company should pay for.

Hope this helps!!

> Good news (I think)! My husband brought home some info from work

and it looks like we get another appeal. Now that Cigna has made

their final denial, we can submit an appeal to the Employee Benefits

Committee at his Employer. All they want is our final denial letter

and an explanation of why we think the claim was denied in error.

Ah, let me count the ways...

>

> Has anyone done this before? What approach would you take? If you

were me, would you take the time to point out all the ways in which

Cigna has abused us, or would you just stick to the medical facts?

This one might actually count for something because it will never

even get sent to Cigna, and Nortel could force them to pay!

>

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

[Guest guest]

,

Thank you so much. This all makes great sense, especially #4. I have been pretty emotional throughout this whole thing, which is why I do all the work and then let my husband (the businessman) write the letters. I'll let you know how it goes.

Gail

Re: We get another appeal!

Hi Gail,I've appealed other insurance decisions and have found the following tactics helpful:1) Stick to the facts. As tempting as it is to point out how awful Cigna is, keep in mind that - to someone who isn't familiar with the situation and all you've gone through - this could be distracting and make you appear unreasonable. 2) Bring in as much documentation as you can - but keep it straight forward. Present letters from your doctors, Cranial Technologies, etc that clearly state why the treatment was medically necessary. Bring along any medical articles you can find - especially something on the DOC Band being FDA approved and the standard of care for this condition. By bringing all this evidence why this should be paid for, you make it easier for the Committee to rule in your favor. 3) Find out how many people will be hearing the appeal (if possible), and bring a copy of your presentation for each of them. It helps to see things in front of them.4) Don't be emotional. If you attack the insurance company, they might get defensive (remember, they CHOSE Cigna as their insurance carrier). You need to seem like YOU are the reasonable one here - its fine to point out mistakes Cigna made (like mixing up the twins and claiming falsely that your doctor has a financial interest in the treatment), but be aware that none of those issues will make them decide to pay for the treatment. And, harping on picky issues makes it hard for them to see the big picture - your children had a medically treatable problem which was corrected using an FDA approved device - which your insurance company should pay for.Hope this helps!!> Good news (I think)! My husband brought home some info from work and it looks like we get another appeal. Now that Cigna has made their final denial, we can submit an appeal to the Employee Benefits Committee at his Employer. All they want is our final denial letter and an explanation of why we think the claim was denied in error. Ah, let me count the ways...> > Has anyone done this before? What approach would you take? If you were me, would you take the time to point out all the ways in which Cigna has abused us, or would you just stick to the medical facts? This one might actually count for something because it will never even get sent to Cigna, and Nortel could force them to pay!> > Gail, Sam and Sara's mom, DOC gradsFor more plagio info

[Guest guest]

Gail:

This does sound promising. I would bring up all of Cigna's errors,

lies, etc. in your next appeal. Those issues should be and NEED to

be made aware of.

Good luck with this, I'm sure you can find plenty of things to put

$6,000 towards.

Debbie Abby's mom DOCGrad

MI

> Good news (I think)! My husband brought home some info from work

and it looks like we get another appeal. Now that Cigna has made

their final denial, we can submit an appeal to the Employee Benefits

Committee at his Employer. All they want is our final denial letter

and an explanation of why we think the claim was denied in error.

Ah, let me count the ways...

>

> Has anyone done this before? What approach would you take? If you

were me, would you take the time to point out all the ways in which

Cigna has abused us, or would you just stick to the medical facts?

This one might actually count for something because it will never

even get sent to Cigna, and Nortel could force them to pay!

>

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

[Guest guest]

Gail,

I was going to tell you to list every single thing that Cigna has

done along the way, but then I read 's response to you! She

does have some very valid points as to why you should stick to the

facts. So now I just want to wish you luck with it all!! I'm

holding you to having that party if Cigna finally pays ;o)

Good Luck!

Niki

Kaylie & Danny (STAR grads)

Phila., PA

> Good news (I think)! My husband brought home some info from work

and it looks like we get another appeal. Now that Cigna has made

their final denial, we can submit an appeal to the Employee Benefits

Committee at his Employer. All they want is our final denial letter

and an explanation of why we think the claim was denied in error.

Ah, let me count the ways...

>

> Has anyone done this before? What approach would you take? If you

were me, would you take the time to point out all the ways in which

Cigna has abused us, or would you just stick to the medical facts?

This one might actually count for something because it will never

even get sent to Cigna, and Nortel could force them to pay!

>

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