Re: Update - Angel

[Guest guest]

Hi ,

I hope you're right about them taking it seriously! I

am getting a letter from my Dr's as quickly as I can

but since I don't even get to see all of them until

the first week in May, I think I'll probably have to

go through an appeals process. I was told that they

were only looking into okaying my out of network

consult. But it sounds like they are considering the

surgery too. If that's true, they won't have all the

pieces to the puzzle until May 24th as that's when I

go to Dr. Hess' office to see Dr. Oakley. So I expect

a denial and on appeal I will have everything in to

Dr. Oakley so he can send it in with his report. At

least that's the way it seems to be playing out. So

you think I should send the letters in as I get them

or will it make more of an impact sending them in

along with Dr. Oakley's report?

Thanks for the encouragemaent and info. Have you heard

anything about your approval? Where are you in the

process? Good Luck and hope to hear from you again

soon, Angel

--- TRISH ZIMMERMANN thin4lifenow2001@...>

wrote:

> > 2. I called my contact, Tammy, at Cigna Ins. Co.

> and

> > she told me that > the Medical Director was

> sending

> Dr. Hess' report> and my letters, > pictures etc.,to

> (I think she called it), a Medical> Review Board.

> She

> > said it would be about a week before I would get a

> > determination and > she would call me first thing

> she heard. Does anyone> know what this > means

> (maybe

> just a reason to back up a no?) Or> maybe it could

> mean > that they are taking my request seriously

> (and

> the> increasing > requests of others)for the BPD/DS

> surgery.

>

> Angel,

> this means that they are taking it seriously and

> that

> you could/should be close to meeting their criteria,

> which is why it is in medical review. Cigna is

> notorious for that, but at least it means either a

> MD

> or a panel of health care professionals are looking

> at

> the whole picture of whether it is medically

> necessary

> for you - and taking a look at your individual plan

> to

> see if it comes under your coverage. If you can get

> those other letters ASAP and have it included in the

> medical review - you could potentially save yourself

> from the appeals process - as without all the pieces

> to the puzzle, they can put it on hold while they

> request additional information. Yes, it can be a

> stall tactic, but more than likely, as my experience

> with Cigna, they are taking it serously. So get as

> much to them (via fax or fed ex overnight if you

> have

> to) so they can make a sound medical decision.

>

> Will keep you in my thoughts and prayers!

>

>

>

>

> __________________________________________________

>