Cigna

[Guest guest]

Hi

I pasted below what my Benefits manager said regarding our Cigna plan

(at the time they were Healthsource. This note is from April after I

received my denial. My lawyer is now filing a complaint with NC

insurance commission. My Benefits manager is going to let me know

which insurance policy I can switch to in November that will cover

this. I hope one of my three choices will let me proceed with my

dream of this surgery. Although I wrote a good appeal letter and had

legal representation I could not get Cigna to budge....

:

Diane has passed along to me information concerning your appeal with

Healthsource and your request for a letter from us. Unfortunately,

it is not Clariant's policy to write letters for appeals to the

HMOs. Clariant has a fully insured arrangemeet with all the HMOs

that the Company offers. This means that we pay a set amount per

employee/family in return for the HMO company providing us with a

standard HMO plan (registered in the state they do business in). As

part of this arrangement, they are responsible for all adminstrative

aspects of the plan as well as all assets and liabilities associated

with plan. Hence, the Company has no say in how or what they

determine to be medically necessary treatment or their appeal process.

I have read your April 20, 2000 draft letter to the

CIGNA/Healthsource Grievance Department. I have no problem with the

sentences you highlighted in your second paragraph. They are

accurate statements.

As a whole, this is one of the better written appeals letter that I

have seen and I wish you luck in your appeal with Healthsource.

Vickie