Re: Hi friends... insurance woes

June 20, 2000

Hi Friends,

Well, someone said (more than one person, in fact) that the best way to get

anywhere with our beloved insurance companies is to follow up with persistent

phone calls. After choosing the more traditional mail-and-wait approach and

getting nowhere, I decided (today must be a brave day-- LOL) to call and see

where our 3rd appeal had landed and what was happening with it. Thank God I

did!

A brief history of the chain of events to date:

We contact Dr R for surgery for our daughter Chris

Dr R sends initial letter to Cigna

Cigna sends refusal due to " out of network " clause

We send appeal to the Ohio office as stipulated

Cigna refuses second level appeal and invites us to submit 3rd and " final "

appeal to Chicago office

We send appeal to Chicago and wait...

Today I read something from one of you wonderful people and decide to call.

I am told that I sent it to the wrong person. I get transferred to the

" right person, " but instead of being connected, a message tells me I have

reached an empty voice mail box. I call back and start at square one with an

operator. I tell her that I need someone who is willing to go above and

beyond to help me. I calmly plead my case and she (bless her heart) takes

pity on my. She says that the " right person " has left the company as of last

Friday. I tell her that she is the ONE person who has been willing to help

and ask her if she will do whatever she can to find out where my appeal

packet is and who would review it. She is gone for at least 3

elevator-music-songs-on-the-line, but that is OK. Someone is

checking--someone is helping. She tells me that I need to talk to the

Appeals Co-ordinator who is a nurse named Gail. She transfers me (yes, I got

her number in case of a disconnect) and I slowly, calmly, and I'm proud to

say even cheerfully (no, I was not feeling the least bit cheerful) tell her

our long saga. Many times she starts to give me the company line. She

finally looks us up on the computer and sees that she only last night before

leaving for the day put our materials in an envelope to GO BACK TO OHIO.

Finally she agrees to just check, and yes, she retrieves the envelope which

she then opens and actually looks through. Still, tho, she repeats the

company line. I do not let her get close to hanging up. My time is her

time. Many times I keep restating the facts:

....yes, I know Dr R is out of network, but are you aware that the surgeon you

(Cigna) recommends in IL does a more complicated, less successful, MORE

EXPENSIVE surgery? Yes, I know he is out of state.....but I am in contact

with MANY Cigna patients who have been out of state and have had the

surgery....will you kindly look at our packet....yes, that's what I have been

saying, we HAVE done our homework...yes, those ARE the diagrams of the 2

surgeries....yes, yes, yes. (Now, won't you please say yes!?)

She tells me to hold on. My brain works overtime through the elevator music.

On her return I appeal to her human, motherly side, sharing my daughter's

history and the desperate state she is in. Usually I talk very fast when I

am excited, but for some reason my voice is steady, slow and clear. Somehow,

thank you Lord, I reach something in her and she agrees to walk my packet

over to the Medical Associate Director (yes, I get his name). She can't

promise anything but she says she will get back to me today or tomorrow. I

thank her profusely, remembering to use my deep voice and not the

high-pitched, desperate one (yes, I am feeling desperate). I gently remind

her of the several KEY points, ending with the " ...WHOLE LOT LESS MONEY " part.

Now I am committed. I will not let this rest. I recommend to all of you, my

new and already very dear friends who are also in the middle of this

insurance company dance, to hop on the airwaves if you are currently

roadblocked in snail mail. Heaven knows where I'll get with Nurse Gail, but

thank God I have a name and someone who is putting a stop to playing " pass

the patient packet! " (alliteration can be a beautiful thing...sorry, I'm a

former English teacher :0)

Thanks for the support, friends.....

Regards,

Debbie in IL

June 20, 2000