Re: Battling with the Insurance Co - CIGNA PPO

[Guest guest]

BLESS YOU, MARY! I, too, have been awaiting approval from Cigna

(traditional/PPO). My Dr. sent the packet on 3/28. Cigna still doesn't " show

it on the screen " ; in other words, they took their time opening the mail &

it's still in review (for 4 weeks!). One of Dr. Ren's patient's received HER

approval (from BC/BS of S. Dakota) within days of her request! I guess I'll

give it til May 1 and then use your technique to HOUND them! Good luck to

you in your quest; hope we both get lucky!

Marcia

> Battling with the Insurance Co - CIGNA PPO

>

>

> I called my insurer today to confrim they recieved my faxed Letter of

> Medical Necessity that was sent to them last week from my DRS office.

>

> CIGNA PPO of course has no record of a fax being sent last week. (The

> Drs office called me last week to let me know once they had faxed it

> out).

>

> Since I had to have the DRS office resend I wanted to make sure the

> LOMN included the necessary details so I asked again for CIGNA to

> tell me what the critera Was as I got mixed messages the last time I

> asked via phone call and query to their internet site. The criteria

> on the internet site was much harder than what was read to me over

> the phone on a previous query.

>

> They told me there was no criteria. I said I knew there was because

> Cigna told me what it was the last time I called as they looked it up

> and read if off the screen to me.

>

> They of course had no record of me calling. I responded with " then

> how did I know the fax number as its not on your ID card, how did I

> know to request a PREDETERMINATION with LOMN if you didnt tell me?

>

> They supposedly looked it up and asked a supervisor who said there

> was no criteria.

>

> Cigna didnt give me the criteria until I pressed yet agian and then

> quoted this to them:

>

> California Health & Safety Code section 1363.5 mandates access to

> these criteria including identification of the authors of the

> criteria, the clinical principles utilized to develop the criteria,

> the last time it was reviewed and updated, etc

>

> This time they miraculously found the criteria, and they were more

> certain of telling me all as I was upset. Ok so this time (third

> different version) they told me the pre determination request for

> gastric bypass needed to include the Letter of Medical Necessity

> (LOMN) whose criteria included:

>

> History

> Physical

> Height

> Weight

> Frame Size

> Recent Labs

> Blood Pressure

> Medicines

> Treatment Plan

> Prognosis

>

> Note... no mention of detailed diet history containing 3 medically

> supervised weight loss programs in the last five years as the info

> from a query to the generic Cinga site said.(ie for PPO, HMO?)

>

> Cigna PPO FAX :

> you need to get a person's name and desk number to fax " ATTENTION "

>

> Some insurers refuse to provide access to the criteria for medical

> necessity, even when denials are based on failures to

> meet " criteria. " Ask how anyone can successfully challenge such a

> denial without access to the criteria and background information upon

> which it is based.

>

> Lesson learned..

>

> Ask for the name and desk number/extentsion number of the person you

> talk to and document it with the date you phoned and the info given

> and recieved.

>

> Dont assume they recieve a fax... make them look in your record!

>

> mary bmi 68

> corona,ca

> awaiting insurance approval

> Dr Rabkin, San Francisco

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

BLESS YOU, MARY! I, too, have been awaiting approval from Cigna

(traditional/PPO). My Dr. sent the packet on 3/28. Cigna still doesn't " show

it on the screen " ; in other words, they took their time opening the mail &

it's still in review (for 4 weeks!). One of Dr. Ren's patient's received HER

approval (from BC/BS of S. Dakota) within days of her request! I guess I'll

give it til May 1 and then use your technique to HOUND them! Good luck to

you in your quest; hope we both get lucky!

Marcia

> Battling with the Insurance Co - CIGNA PPO

>

>

> I called my insurer today to confrim they recieved my faxed Letter of

> Medical Necessity that was sent to them last week from my DRS office.

>

> CIGNA PPO of course has no record of a fax being sent last week. (The

> Drs office called me last week to let me know once they had faxed it

> out).

>

> Since I had to have the DRS office resend I wanted to make sure the

> LOMN included the necessary details so I asked again for CIGNA to

> tell me what the critera Was as I got mixed messages the last time I

> asked via phone call and query to their internet site. The criteria

> on the internet site was much harder than what was read to me over

> the phone on a previous query.

>

> They told me there was no criteria. I said I knew there was because

> Cigna told me what it was the last time I called as they looked it up

> and read if off the screen to me.

>

> They of course had no record of me calling. I responded with " then

> how did I know the fax number as its not on your ID card, how did I

> know to request a PREDETERMINATION with LOMN if you didnt tell me?

>

> They supposedly looked it up and asked a supervisor who said there

> was no criteria.

>

> Cigna didnt give me the criteria until I pressed yet agian and then

> quoted this to them:

>

> California Health & Safety Code section 1363.5 mandates access to

> these criteria including identification of the authors of the

> criteria, the clinical principles utilized to develop the criteria,

> the last time it was reviewed and updated, etc

>

> This time they miraculously found the criteria, and they were more

> certain of telling me all as I was upset. Ok so this time (third

> different version) they told me the pre determination request for

> gastric bypass needed to include the Letter of Medical Necessity

> (LOMN) whose criteria included:

>

> History

> Physical

> Height

> Weight

> Frame Size

> Recent Labs

> Blood Pressure

> Medicines

> Treatment Plan

> Prognosis

>

> Note... no mention of detailed diet history containing 3 medically

> supervised weight loss programs in the last five years as the info

> from a query to the generic Cinga site said.(ie for PPO, HMO?)

>

> Cigna PPO FAX :

> you need to get a person's name and desk number to fax " ATTENTION "

>

> Some insurers refuse to provide access to the criteria for medical

> necessity, even when denials are based on failures to

> meet " criteria. " Ask how anyone can successfully challenge such a

> denial without access to the criteria and background information upon

> which it is based.

>

> Lesson learned..

>

> Ask for the name and desk number/extentsion number of the person you

> talk to and document it with the date you phoned and the info given

> and recieved.

>

> Dont assume they recieve a fax... make them look in your record!

>

> mary bmi 68

> corona,ca

> awaiting insurance approval

> Dr Rabkin, San Francisco

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

" I guess I'll give it til May 1 and then use your technique to HOUND

them! Good luck to you in your quest; hope we both get lucky! "

Have you tried calling and asking them to confirm if they have

received your LOMN?

If you havent, do so! If your LOMN has not be confirmed as being

recieived, ask for the person's name and her desk number.Then use the

fax number and REFAX your LOMN with " ATTENTION " to that person and

desk number. Ask them to phone you back when its been received.

They told me at Cigna today that a fax that came in to no one in

particular would just sit in a pile!!!

Dont wait til May first if you dont even know if they have reicved

it.. if they have recieved it then you can wait the 10-15 business

days...

good luck,

mary