Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 , Dave, Steve...and gang... Gather 'round, Hippy Kids and I'll tell you a story. You know it won't be real happy, since it involves an insurance (say, what???) company. Called CIGNA's predetermination office today (Nikki at JRI said I'd likely get more out them than she would, unless a request for coverage had already been approved or denied. She hadn't heard anything, and I know I haven't.) After futzing with the phone tree for a few minutes, I got a sweet young thing (heretofore to be known as SYT) who didn't know anything about my case. I spelled it, she went to look...came back and said " this is the Medical device? " I said...yes. She said the request had been submitted for review on June 8th. Now the observant hippy will note I had seen Dr. Amstutz on May 5th. The young CIGNA thing confirms that, indeed they did get the papers from JRI on MAY 10th. And then she says " we submitted the case for review JUNE 8th. " To which I said... " what happened in the month between May 10 June 8? " She said: " Nothing happened, until we filed the request for review. " " A month after it arrived? " I asked...believing, but not wanting to. " Well, yes, " she said. Me: " So what happens now? " SYT: " We should have an answer within 30 business days " . ME: " Whoa, now. I called two weeks ago tomorrow, and you told me we've and answer in three to five working days...HOW DOES THAT HAPPEN? " SYT: " I don't know for sure " ME: " You're telling me CIGNA left my case sitting on a desk untouched for a month, now I get to wait 30 more business days? " SYT: " Well, that's how long the review takes " . ME: " You told me three to five days...two weeks ago. Do you have any way to speed this process? " SYT: " We could make as a priority case. " ME: " Does that mean the process would start over? " SYT: " Yes. " ME: " If we start over, and you mark the file " priority " ... how long before we have an answer? " SYT: " Ten business day. " ME: " What would it take to mark it " priority " ? SYT: " I could do that right now. " ME: " Well, would you please do it now? " SYT: " Yes, sir. " There were a few more niceties, but you get the picture. I wouldn't be the least surprised if CIGNA denied the coverage just because I made some noise, but the alternative was really no better. A long story with no punchline... I'm off to a photo shop to see if I can get my x-rays digitized for the e-trip to Belgium. I don't have a very good feeling about what will happen in a CIGNA " priority " review...or how long the papers will sit somewhere before a review committee actually does see them; or for that matter whether the review amounts to a guy named Norm standing at the stairs and tossing case files... the lower the file lands on the steps, the longer you wait, and the more likely you are to be denied. My file may have landed in the basement. Hobble on, Hippies.. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 HI Alan, From one Californian to another, I'd like to say, " Dude, that really sucks. " I guess there was no use talking to the SYT's superior? I always try to claw my way to someone higher if my back is against the wall. Sometimes with results. Sometimes it only serves to make them mark my file " A-hole " and move it to the bottom of the stack. It just ain't right, bro. Especially a nice guy like yourself, just trying to live life and be happy. It's not like your asking for a sex change. The beautiful part of all this will be the end result, whether the Cigna pendejos have your back, or whether your'e off to see za vizard of Ghent. My hip feels BITCHEN, and yours is gonna feel bitchen too. Who knows? Maybe your'e just not meant to gag down LAOH slop? Trust me, brother Alan, that's a good thing. And besides...lets be honest...the belgian hippies sound like they party harder than the JRI crowd. A few more weeks and you'll have your answer, and your head will be full of nothing but positive things thereafter. And regardless if your worked on by Craftsman or Bosch tools, you'll be a happy handballer again in no time. Hang tough, and don't let the bastards drag you down! Chris > , Dave, Steve...and gang... > > Gather 'round, Hippy Kids and I'll tell you a story. You know it > won't be real happy, since it involves an insurance (say, what???) > company. > > Called CIGNA's predetermination office today (Nikki at JRI said I'd > likely get more out them than she would, unless a request for > coverage had already been approved or denied. She hadn't heard > anything, and I know I haven't.) After futzing with the phone tree > for a few minutes, I got a sweet young thing (heretofore to be known > as SYT) who didn't know anything about my case. I spelled it, she > went to look...came back and said " this is the Medical > device? " I said...yes. She said the request had been submitted for > review on June 8th. > > Now the observant hippy will note I had seen Dr. Amstutz on May 5th. > The young CIGNA thing confirms that, indeed they did get the papers > from JRI on MAY 10th. And then she says " we submitted the case for > review JUNE 8th. " > > To which I said... " what happened in the month between May 10 June 8? " > > She said: " Nothing happened, until we filed the request for review. " > > " A month after it arrived? " I asked...believing, but not wanting to. > > " Well, yes, " she said. > > Me: " So what happens now? " > > SYT: " We should have an answer within 30 business days " . > > ME: " Whoa, now. I called two weeks ago tomorrow, and you told me > we've and answer in three to five working days...HOW DOES THAT > HAPPEN? " > > SYT: " I don't know for sure " > > ME: " You're telling me CIGNA left my case sitting on a desk untouched > for a month, now I get to wait 30 more business days? " > > SYT: " Well, that's how long the review takes " . > > ME: " You told me three to five days...two weeks ago. Do you have any > way to speed this process? " > > SYT: " We could make as a priority case. " > > ME: " Does that mean the process would start over? " > > SYT: " Yes. " > > ME: " If we start over, and you mark the file " priority " ... how long > before we have an answer? " > > SYT: " Ten business day. " > > ME: " What would it take to mark it " priority " ? > > SYT: " I could do that right now. " > > ME: " Well, would you please do it now? " > > SYT: " Yes, sir. " > > There were a few more niceties, but you get the picture. I wouldn't > be the least surprised if CIGNA denied the coverage just because I > made some noise, but the alternative was really no better. > > A long story with no punchline... I'm off to a photo shop to see if > I can get my x-rays digitized for the e-trip to Belgium. I don't > have a very good feeling about what will happen in a CIGNA " priority " > review...or how long the papers will sit somewhere before a review > committee actually does see them; or for that matter whether the > review amounts to a guy named Norm standing at the stairs and tossing > case files... the lower the file lands on the steps, the longer you > wait, and the more likely you are to be denied. My file may have > landed in the basement. > > Hobble on, Hippies.. > Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 I'm sorry you are having such a hard time with the insurance companies. My surgeon simply called and got pre-approval for a THR and coded it as such. I had both hips done on the same day and my insurance company didn't " blink an eye " . It's all in how the insurance company is approached! I know it's too late to help you with this information, but maybe others can benefit from it. Good luck! Dianne Bil C+ 8-25-04 > >Reply-To: surfacehippy >To: surfacehippy >Subject: Alan's update:: :=( >Date: Tue, 06 Jul 2004 21:50:53 -0000 > >, Dave, Steve...and gang... > >Gather 'round, Hippy Kids and I'll tell you a story. You know it >won't be real happy, since it involves an insurance (say, what???) >company. > >Called CIGNA's predetermination office today (Nikki at JRI said I'd >likely get more out them than she would, unless a request for >coverage had already been approved or denied. She hadn't heard >anything, and I know I haven't.) After futzing with the phone tree >for a few minutes, I got a sweet young thing (heretofore to be known >as SYT) who didn't know anything about my case. I spelled it, she >went to look...came back and said " this is the Medical >device? " I said...yes. She said the request had been submitted for >review on June 8th. > >Now the observant hippy will note I had seen Dr. Amstutz on May 5th. >The young CIGNA thing confirms that, indeed they did get the papers >from JRI on MAY 10th. And then she says " we submitted the case for >review JUNE 8th. " > >To which I said... " what happened in the month between May 10 June 8? " > >She said: " Nothing happened, until we filed the request for review. " > > " A month after it arrived? " I asked...believing, but not wanting to. > > " Well, yes, " she said. > >Me: " So what happens now? " > >SYT: " We should have an answer within 30 business days " . > >ME: " Whoa, now. I called two weeks ago tomorrow, and you told me >we've and answer in three to five working days...HOW DOES THAT >HAPPEN? " > >SYT: " I don't know for sure " > >ME: " You're telling me CIGNA left my case sitting on a desk untouched >for a month, now I get to wait 30 more business days? " > >SYT: " Well, that's how long the review takes " . > >ME: " You told me three to five days...two weeks ago. Do you have any >way to speed this process? " > >SYT: " We could make as a priority case. " > >ME: " Does that mean the process would start over? " > >SYT: " Yes. " > >ME: " If we start over, and you mark the file " priority " ... how long >before we have an answer? " > >SYT: " Ten business day. " > >ME: " What would it take to mark it " priority " ? > >SYT: " I could do that right now. " > >ME: " Well, would you please do it now? " > >SYT: " Yes, sir. " > >There were a few more niceties, but you get the picture. I wouldn't >be the least surprised if CIGNA denied the coverage just because I >made some noise, but the alternative was really no better. > >A long story with no punchline... I'm off to a photo shop to see if >I can get my x-rays digitized for the e-trip to Belgium. I don't >have a very good feeling about what will happen in a CIGNA " priority " >review...or how long the papers will sit somewhere before a review >committee actually does see them; or for that matter whether the >review amounts to a guy named Norm standing at the stairs and tossing >case files... the lower the file lands on the steps, the longer you >wait, and the more likely you are to be denied. My file may have >landed in the basement. > >Hobble on, Hippies.. >Alan > _________________________________________________________________ FREE pop-up blocking with the new MSN Toolbar – get it now! http://toolbar.msn.click-url.com/go/onm00200415ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 Diane, Who are is your insurance with? Chris > I'm sorry you are having such a hard time with the insurance companies. My > surgeon simply called and got pre-approval for a THR and coded it as such. > I had both hips done on the same day and my insurance company didn't " blink > an eye " . It's all in how the insurance company is approached! I know it's > too late to help you with this information, but maybe others can benefit > from it. Good luck! > Dianne > Bil C+ 8-25-04 > > > >From: " Alan Ray " > >Reply-To: surfacehippy > >To: surfacehippy > >Subject: Alan's update:: :=( > >Date: Tue, 06 Jul 2004 21:50:53 -0000 > > > >, Dave, Steve...and gang... > > > >Gather 'round, Hippy Kids and I'll tell you a story. You know it > >won't be real happy, since it involves an insurance (say, what???) > >company. > > > >Called CIGNA's predetermination office today (Nikki at JRI said I'd > >likely get more out them than she would, unless a request for > >coverage had already been approved or denied. She hadn't heard > >anything, and I know I haven't.) After futzing with the phone tree > >for a few minutes, I got a sweet young thing (heretofore to be known > >as SYT) who didn't know anything about my case. I spelled it, she > >went to look...came back and said " this is the Medical > >device? " I said...yes. She said the request had been submitted for > >review on June 8th. > > > >Now the observant hippy will note I had seen Dr. Amstutz on May 5th. > >The young CIGNA thing confirms that, indeed they did get the papers > >from JRI on MAY 10th. And then she says " we submitted the case for > >review JUNE 8th. " > > > >To which I said... " what happened in the month between May 10 June 8? " > > > >She said: " Nothing happened, until we filed the request for review. " > > > > " A month after it arrived? " I asked...believing, but not wanting to. > > > > " Well, yes, " she said. > > > >Me: " So what happens now? " > > > >SYT: " We should have an answer within 30 business days " . > > > >ME: " Whoa, now. I called two weeks ago tomorrow, and you told me > >we've and answer in three to five working days...HOW DOES THAT > >HAPPEN? " > > > >SYT: " I don't know for sure " > > > >ME: " You're telling me CIGNA left my case sitting on a desk untouched > >for a month, now I get to wait 30 more business days? " > > > >SYT: " Well, that's how long the review takes " . > > > >ME: " You told me three to five days...two weeks ago. Do you have any > >way to speed this process? " > > > >SYT: " We could make as a priority case. " > > > >ME: " Does that mean the process would start over? " > > > >SYT: " Yes. " > > > >ME: " If we start over, and you mark the file " priority " ... how long > >before we have an answer? " > > > >SYT: " Ten business day. " > > > >ME: " What would it take to mark it " priority " ? > > > >SYT: " I could do that right now. " > > > >ME: " Well, would you please do it now? " > > > >SYT: " Yes, sir. " > > > >There were a few more niceties, but you get the picture. I wouldn't > >be the least surprised if CIGNA denied the coverage just because I > >made some noise, but the alternative was really no better. > > > >A long story with no punchline... I'm off to a photo shop to see if > >I can get my x-rays digitized for the e-trip to Belgium. I don't > >have a very good feeling about what will happen in a CIGNA " priority " > >review...or how long the papers will sit somewhere before a review > >committee actually does see them; or for that matter whether the > >review amounts to a guy named Norm standing at the stairs and tossing > >case files... the lower the file lands on the steps, the longer you > >wait, and the more likely you are to be denied. My file may have > >landed in the basement. > > > >Hobble on, Hippies.. > >Alan > > > > _________________________________________________________________ > FREE pop-up blocking with the new MSN Toolbar – get it now! > http://toolbar.msn.click-url.com/go/onm00200415ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 Yo, Sometimes only another language allows the perfect word. " Pendejos " would be the word, amigo. Not much point, I thought, in talking to a superior if SYT said she'd mark it " priority " . My real belief is that that and $4.00 will get you drinkable coffee at Stabucks. The words about bastards grinding in Latin, where I learned them first are: Illegitimi non caroborundum. And being an inveterate handball player if immense desire and marginal skills, I can assure you THEY WILL NOT GRIND ME DOWN. As to the party crowd in Ghent, I can't sing a lick, don't dance for s--t... but I can party with the really good ones. I'll keep in touch. Thanks for kind words...you non-hobblin' hippy, you. Alan Trust me, brother Alan, that's a good > thing. And besides...lets be honest...the belgian hippies sound like > they party harder than the JRI crowd. A few more weeks and you'll > have your answer, and your head will be full of nothing but positive > things thereafter. And regardless if your worked on by Craftsman or > Bosch tools, you'll be a happy handballer again in no time. Hang > tough, and don't let the bastards drag you down! > > Chris > > > > > > > , Dave, Steve...and gang... > > > > Gather 'round, Hippy Kids and I'll tell you a story. You know it > > won't be real happy, since it involves an insurance (say, what???) > > company. > > > > Called CIGNA's predetermination office today (Nikki at JRI said > I'd > > likely get more out them than she would, unless a request for > > coverage had already been approved or denied. She hadn't heard > > anything, and I know I haven't.) After futzing with the phone > tree > > for a few minutes, I got a sweet young thing (heretofore to be > known > > as SYT) who didn't know anything about my case. I spelled it, she > > went to look...came back and said " this is the Medical > > device? " I said...yes. She said the request had been submitted > for > > review on June 8th. > > > > Now the observant hippy will note I had seen Dr. Amstutz on May > 5th. > > The young CIGNA thing confirms that, indeed they did get the > papers > > from JRI on MAY 10th. And then she says " we submitted the case > for > > review JUNE 8th. " > > > > To which I said... " what happened in the month between May 10 June > 8? " > > > > She said: " Nothing happened, until we filed the request for > review. " > > > > " A month after it arrived? " I asked...believing, but not wanting > to. > > > > " Well, yes, " she said. > > > > Me: " So what happens now? " > > > > SYT: " We should have an answer within 30 business days " . > > > > ME: " Whoa, now. I called two weeks ago tomorrow, and you told me > > we've and answer in three to five working days...HOW DOES THAT > > HAPPEN? " > > > > SYT: " I don't know for sure " > > > > ME: " You're telling me CIGNA left my case sitting on a desk > untouched > > for a month, now I get to wait 30 more business days? " > > > > SYT: " Well, that's how long the review takes " . > > > > ME: " You told me three to five days...two weeks ago. Do you have > any > > way to speed this process? " > > > > SYT: " We could make as a priority case. " > > > > ME: " Does that mean the process would start over? " > > > > SYT: " Yes. " > > > > ME: " If we start over, and you mark the file " priority " ... how > long > > before we have an answer? " > > > > SYT: " Ten business day. " > > > > ME: " What would it take to mark it " priority " ? > > > > SYT: " I could do that right now. " > > > > ME: " Well, would you please do it now? " > > > > SYT: " Yes, sir. " > > > > There were a few more niceties, but you get the picture. I > wouldn't > > be the least surprised if CIGNA denied the coverage just because I > > made some noise, but the alternative was really no better. > > > > A long story with no punchline... I'm off to a photo shop to see > if > > I can get my x-rays digitized for the e-trip to Belgium. I don't > > have a very good feeling about what will happen in a > CIGNA " priority " > > review...or how long the papers will sit somewhere before a review > > committee actually does see them; or for that matter whether the > > review amounts to a guy named Norm standing at the stairs and > tossing > > case files... the lower the file lands on the steps, the longer > you > > wait, and the more likely you are to be denied. My file may have > > landed in the basement. > > > > Hobble on, Hippies.. > > Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 Hey Alan, It is possible that my Cigna story tops yours. I just received a letter TODAY stating that Cigna finally has all of the information I have sent in (all 37 pages) and it has been forwarded to Claim Processing.. furthermore I should allow 30-45 days for the claim to be processed. Fine and dandy considering that my surgery was nearly TWO- yes that's right- TWO years ago!!! Glad I didn't need to be a slave to my insurance.....I'll keep you posted as to the final outcome---'course it sounds like you will have your info before me! Regards, Rock climbin' Jude LBHR De Smet 09/11/02 Alan's update:: :=( , Dave, Steve...and gang... Gather 'round, Hippy Kids and I'll tell you a story. You know it won't be real happy, since it involves an insurance (say, what???) company. Called CIGNA's predetermination office today (Nikki at JRI said I'd likely get more out them than she would, unless a request for coverage had already been approved or denied. She hadn't heard anything, and I know I haven't.) After futzing with the phone tree for a few minutes, I got a sweet young thing (heretofore to be known as SYT) who didn't know anything about my case. I spelled it, she went to look...came back and said " this is the Medical device? " I said...yes. She said the request had been submitted for review on June 8th. Now the observant hippy will note I had seen Dr. Amstutz on May 5th. The young CIGNA thing confirms that, indeed they did get the papers from JRI on MAY 10th. And then she says " we submitted the case for review JUNE 8th. " To which I said... " what happened in the month between May 10 June 8? " She said: " Nothing happened, until we filed the request for review. " " A month after it arrived? " I asked...believing, but not wanting to. " Well, yes, " she said. Me: " So what happens now? " SYT: " We should have an answer within 30 business days " . ME: " Whoa, now. I called two weeks ago tomorrow, and you told me we've and answer in three to five working days...HOW DOES THAT HAPPEN? " SYT: " I don't know for sure " ME: " You're telling me CIGNA left my case sitting on a desk untouched for a month, now I get to wait 30 more business days? " SYT: " Well, that's how long the review takes " . ME: " You told me three to five days...two weeks ago. Do you have any way to speed this process? " SYT: " We could make as a priority case. " ME: " Does that mean the process would start over? " SYT: " Yes. " ME: " If we start over, and you mark the file " priority " ... how long before we have an answer? " SYT: " Ten business day. " ME: " What would it take to mark it " priority " ? SYT: " I could do that right now. " ME: " Well, would you please do it now? " SYT: " Yes, sir. " There were a few more niceties, but you get the picture. I wouldn't be the least surprised if CIGNA denied the coverage just because I made some noise, but the alternative was really no better. A long story with no punchline... I'm off to a photo shop to see if I can get my x-rays digitized for the e-trip to Belgium. I don't have a very good feeling about what will happen in a CIGNA " priority " review...or how long the papers will sit somewhere before a review committee actually does see them; or for that matter whether the review amounts to a guy named Norm standing at the stairs and tossing case files... the lower the file lands on the steps, the longer you wait, and the more likely you are to be denied. My file may have landed in the basement. Hobble on, Hippies.. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 > I'm sorry you are having such a hard time with the insurance companies. My > surgeon simply called and got pre-approval for a THR and coded it as such. Orthopaedic Hospital will not allow JRI to do this. They tried it earlier this year, and the hospital made them resubmit those cases with the annotation that the surgeon would use an investigational device if he thought it appropriate. That's what turned my case (which had already been approved as a THR) into exactly the sort of nightmare struggle with CIGNA bureaucracy that Alan's dealing with right now. 11 weeks post-op, there's been another development in my case: CIGNA decided to disallow $929.20 of the $1000.00 I paid out of pocket for my pre-op autologous blood donation and reimbursed me a whopping $70.80. I don't know whether to call my lawyer or try to buy C4 on the black market. I *really* hate those guys. Steve (bilat C+ 4/20/04, Amstutz) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 > I'm sorry you are having such a hard time with the insurance companies. My > surgeon simply called and got pre-approval for a THR and coded it as such. Orthopaedic Hospital will not allow JRI to do this. They tried it earlier this year, and the hospital made them resubmit those cases with the annotation that the surgeon would use an investigational device if he thought it appropriate. That's what turned my case (which had already been approved as a THR) into exactly the sort of nightmare struggle with CIGNA bureaucracy that Alan's dealing with right now. 11 weeks post-op, there's been another development in my case: CIGNA decided to disallow $929.20 of the $1000.00 I paid out of pocket for my pre-op autologous blood donation and reimbursed me a whopping $70.80. I don't know whether to call my lawyer or try to buy C4 on the black market. I *really* hate those guys. Steve (bilat C+ 4/20/04, Amstutz) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2004 Report Share Posted July 6, 2004 > I'm sorry you are having such a hard time with the insurance companies. My > surgeon simply called and got pre-approval for a THR and coded it as such. Orthopaedic Hospital will not allow JRI to do this. They tried it earlier this year, and the hospital made them resubmit those cases with the annotation that the surgeon would use an investigational device if he thought it appropriate. That's what turned my case (which had already been approved as a THR) into exactly the sort of nightmare struggle with CIGNA bureaucracy that Alan's dealing with right now. 11 weeks post-op, there's been another development in my case: CIGNA decided to disallow $929.20 of the $1000.00 I paid out of pocket for my pre-op autologous blood donation and reimbursed me a whopping $70.80. I don't know whether to call my lawyer or try to buy C4 on the black market. I *really* hate those guys. Steve (bilat C+ 4/20/04, Amstutz) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2004 Report Share Posted July 7, 2004 medical approaches this procedure (c+ 4 more days) as a THR on the follow-up sheet. This is what I did and insurance approved it for my 7/12 surgery. Actually its nice to see the company's get alittle of their own medicine (no pun intended). > > I'm sorry you are having such a hard time with the insurance > companies. My > > surgeon simply called and got pre-approval for a THR and coded it > as such. > > I had both hips done on the same day and my insurance company > didn't " blink > > an eye " . It's all in how the insurance company is approached! I > know it's > > too late to help you with this information, but maybe others can > benefit > > from it. Good luck! > > Dianne > > Bil C+ 8-25-04 > > > > > > >From: " Alan Ray " > > >Reply-To: surfacehippy > > >To: surfacehippy > > >Subject: Alan's update:: :=( > > >Date: Tue, 06 Jul 2004 21:50:53 -0000 > > > > > >, Dave, Steve...and gang... > > > > > >Gather 'round, Hippy Kids and I'll tell you a story. You know it > > >won't be real happy, since it involves an insurance (say, what???) > > >company. > > > > > >Called CIGNA's predetermination office today (Nikki at JRI said > I'd > > >likely get more out them than she would, unless a request for > > >coverage had already been approved or denied. She hadn't heard > > >anything, and I know I haven't.) After futzing with the phone > tree > > >for a few minutes, I got a sweet young thing (heretofore to be > known > > >as SYT) who didn't know anything about my case. I spelled it, she > > >went to look...came back and said " this is the Medical > > >device? " I said...yes. She said the request had been submitted > for > > >review on June 8th. > > > > > >Now the observant hippy will note I had seen Dr. Amstutz on May > 5th. > > >The young CIGNA thing confirms that, indeed they did get the > papers > > >from JRI on MAY 10th. And then she says " we submitted the case > for > > >review JUNE 8th. " > > > > > >To which I said... " what happened in the month between May 10 > June 8? " > > > > > >She said: " Nothing happened, until we filed the request for > review. " > > > > > > " A month after it arrived? " I asked...believing, but not wanting > to. > > > > > > " Well, yes, " she said. > > > > > >Me: " So what happens now? " > > > > > >SYT: " We should have an answer within 30 business days " . > > > > > >ME: " Whoa, now. I called two weeks ago tomorrow, and you told me > > >we've and answer in three to five working days...HOW DOES THAT > > >HAPPEN? " > > > > > >SYT: " I don't know for sure " > > > > > >ME: " You're telling me CIGNA left my case sitting on a desk > untouched > > >for a month, now I get to wait 30 more business days? " > > > > > >SYT: " Well, that's how long the review takes " . > > > > > >ME: " You told me three to five days...two weeks ago. Do you have > any > > >way to speed this process? " > > > > > >SYT: " We could make as a priority case. " > > > > > >ME: " Does that mean the process would start over? " > > > > > >SYT: " Yes. " > > > > > >ME: " If we start over, and you mark the file " priority " ... how > long > > >before we have an answer? " > > > > > >SYT: " Ten business day. " > > > > > >ME: " What would it take to mark it " priority " ? > > > > > >SYT: " I could do that right now. " > > > > > >ME: " Well, would you please do it now? " > > > > > >SYT: " Yes, sir. " > > > > > >There were a few more niceties, but you get the picture. I > wouldn't > > >be the least surprised if CIGNA denied the coverage just because I > > >made some noise, but the alternative was really no better. > > > > > >A long story with no punchline... I'm off to a photo shop to see > if > > >I can get my x-rays digitized for the e-trip to Belgium. I don't > > >have a very good feeling about what will happen in a > CIGNA " priority " > > >review...or how long the papers will sit somewhere before a review > > >committee actually does see them; or for that matter whether the > > >review amounts to a guy named Norm standing at the stairs and > tossing > > >case files... the lower the file lands on the steps, the longer > you > > >wait, and the more likely you are to be denied. My file may have > > >landed in the basement. > > > > > >Hobble on, Hippies.. > > >Alan > > > > > > > _________________________________________________________________ > > FREE pop-up blocking with the new MSN Toolbar – get it now! > > http://toolbar.msn.click-url.com/go/onm00200415ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2004 Report Share Posted July 7, 2004 medical approaches this procedure (c+ 4 more days) as a THR on the follow-up sheet. This is what I did and insurance approved it for my 7/12 surgery. Actually its nice to see the company's get alittle of their own medicine (no pun intended). > > I'm sorry you are having such a hard time with the insurance > companies. My > > surgeon simply called and got pre-approval for a THR and coded it > as such. > > I had both hips done on the same day and my insurance company > didn't " blink > > an eye " . It's all in how the insurance company is approached! I > know it's > > too late to help you with this information, but maybe others can > benefit > > from it. Good luck! > > Dianne > > Bil C+ 8-25-04 > > > > > > >From: " Alan Ray " > > >Reply-To: surfacehippy > > >To: surfacehippy > > >Subject: Alan's update:: :=( > > >Date: Tue, 06 Jul 2004 21:50:53 -0000 > > > > > >, Dave, Steve...and gang... > > > > > >Gather 'round, Hippy Kids and I'll tell you a story. You know it > > >won't be real happy, since it involves an insurance (say, what???) > > >company. > > > > > >Called CIGNA's predetermination office today (Nikki at JRI said > I'd > > >likely get more out them than she would, unless a request for > > >coverage had already been approved or denied. She hadn't heard > > >anything, and I know I haven't.) After futzing with the phone > tree > > >for a few minutes, I got a sweet young thing (heretofore to be > known > > >as SYT) who didn't know anything about my case. I spelled it, she > > >went to look...came back and said " this is the Medical > > >device? " I said...yes. She said the request had been submitted > for > > >review on June 8th. > > > > > >Now the observant hippy will note I had seen Dr. Amstutz on May > 5th. > > >The young CIGNA thing confirms that, indeed they did get the > papers > > >from JRI on MAY 10th. And then she says " we submitted the case > for > > >review JUNE 8th. " > > > > > >To which I said... " what happened in the month between May 10 > June 8? " > > > > > >She said: " Nothing happened, until we filed the request for > review. " > > > > > > " A month after it arrived? " I asked...believing, but not wanting > to. > > > > > > " Well, yes, " she said. > > > > > >Me: " So what happens now? " > > > > > >SYT: " We should have an answer within 30 business days " . > > > > > >ME: " Whoa, now. I called two weeks ago tomorrow, and you told me > > >we've and answer in three to five working days...HOW DOES THAT > > >HAPPEN? " > > > > > >SYT: " I don't know for sure " > > > > > >ME: " You're telling me CIGNA left my case sitting on a desk > untouched > > >for a month, now I get to wait 30 more business days? " > > > > > >SYT: " Well, that's how long the review takes " . > > > > > >ME: " You told me three to five days...two weeks ago. Do you have > any > > >way to speed this process? " > > > > > >SYT: " We could make as a priority case. " > > > > > >ME: " Does that mean the process would start over? " > > > > > >SYT: " Yes. " > > > > > >ME: " If we start over, and you mark the file " priority " ... how > long > > >before we have an answer? " > > > > > >SYT: " Ten business day. " > > > > > >ME: " What would it take to mark it " priority " ? > > > > > >SYT: " I could do that right now. " > > > > > >ME: " Well, would you please do it now? " > > > > > >SYT: " Yes, sir. " > > > > > >There were a few more niceties, but you get the picture. I > wouldn't > > >be the least surprised if CIGNA denied the coverage just because I > > >made some noise, but the alternative was really no better. > > > > > >A long story with no punchline... I'm off to a photo shop to see > if > > >I can get my x-rays digitized for the e-trip to Belgium. I don't > > >have a very good feeling about what will happen in a > CIGNA " priority " > > >review...or how long the papers will sit somewhere before a review > > >committee actually does see them; or for that matter whether the > > >review amounts to a guy named Norm standing at the stairs and > tossing > > >case files... the lower the file lands on the steps, the longer > you > > >wait, and the more likely you are to be denied. My file may have > > >landed in the basement. > > > > > >Hobble on, Hippies.. > > >Alan > > > > > > > _________________________________________________________________ > > FREE pop-up blocking with the new MSN Toolbar – get it now! > > http://toolbar.msn.click-url.com/go/onm00200415ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
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