I'm new - looking for CIGNA help...

[Guest guest]

Hi Gail -

Looks like you've already received a bunch of good advice. I would recommend

looking back through the April posts for the CIGNA paid post because I

believe that mom offered her assistance to future CIGNA members in this

group. (I believe the post was in April)

Let us know what the denial reason was because the way you approach the

appeal really depends on what the reason for denial was.

I also wanted to say welcome and congrats on your twins! We have lots of

parents of twins here so you will be in good company! I hope you will keep us

posted and let us know if we can help you with anything else!

Marci (Mom to )

Oklahoma

[Guest guest]

Hello, I'm new to the group and I'm looking for help. My 5 1/2 month

old twins, Sara and Sam, have plagio, and CIGNA denied payment for

the bands. We got them anyway - what parent wouldn't do anything

they could to help their child? - and now we are beginning the fight

against CIGNA. Thanks in advance!

Gail

, Texas

[Guest guest]

Gail -

Welcome! On what grounds did CIGNA deny you? You can find appeal

letters for CIGNA under Files/Help/Insurance Help. Hope this

helps! Good luck and keep fighting!

Dane's mom (DOC Band 2/14)

> Hello, I'm new to the group and I'm looking for help. My 5 1/2

month

> old twins, Sara and Sam, have plagio, and CIGNA denied payment for

> the bands. We got them anyway - what parent wouldn't do anything

> they could to help their child? - and now we are beginning the

fight

> against CIGNA. Thanks in advance!

>

> Gail

> , Texas

[Guest guest]

Gail,

Welcome to our world! I have been denied through two appeals with UHC

in Ohio and had my first (and only) one on one hearing yesterday.

The folks at CT said to not be too hopeful of the outcome and that

UHC had made up their minds before the hearing even started. Still,

you have to " go through the motions " and exhaust all internal

channels before you can go to the state for an external review.

I came prepared to the hearing with pie charts and my daughters " head

on a stick " marching into the boardroom. It was hilarious.

So that is where we are. There are three of here in Cleveberg

fighting this all at the same time. What is the actual stated denial

reason they are using?

Interestingly, Where in Texas are you? I actually have been in

touch with a lawyer in Dallas, Texas that was VERY EFFECTIVE in

getting UHC to pay for another girl in Texas. This could be very

helpful to you. Let me know if you are interested in his name.

and Jane

> Hello, I'm new to the group and I'm looking for help. My 5 1/2

month

> old twins, Sara and Sam, have plagio, and CIGNA denied payment for

> the bands. We got them anyway - what parent wouldn't do anything

> they could to help their child? - and now we are beginning the

fight

> against CIGNA. Thanks in advance!

>

> Gail

> , Texas

[Guest guest]

Hi Gail and welcome to our group, and congrats on your twins! I am

also the proud mommy of twins, both of whom needed bands for thier

plagio (those are my cuties on the plagio homepage!) We just had a

member finally get Cigna to pay after going through an external

review. Hopefully , Owen's mom, will chime in here and let you

know about her experiences with CIGNA.

We look forward to getting to know more about you and your babies.

Do you have the bands already? What kind of bands are they getting?

Good luck with Cigna, and again welcome to the group!

Niki

Kaylie & Danny (STAR grads)

Phila., PA

> Hello, I'm new to the group and I'm looking for help. My 5 1/2

month

> old twins, Sara and Sam, have plagio, and CIGNA denied payment for

> the bands. We got them anyway - what parent wouldn't do anything

> they could to help their child? - and now we are beginning the

fight

> against CIGNA. Thanks in advance!

>

> Gail

> , Texas

[Guest guest]

hi Gail & welcome!

We're glad to have you. Like Niki replied, we recently had a mom who

fought & fought with Cigna to get her son's band covered. They

finally did pay! I hope she'll help you & give you good advice on

how to get them to pay. On what grounds did they deny coverage?

Also checkout our " files " section, then the " help " folder,

then " insurance issues " ..I think there is some Cigna info in there.

Are they in the DOCband? They've started at a great age & I'm sure

you'll get very good & fast improvement.

Please keep us posted on their progress as well as your ins. fight.

Welcome again.

Debbie Abby's mom DOCGrad

MI

> --- In Plagiocephaly@y..., " momofivftwins " <howieandgail@a...>

wrote:

> > Hello, I'm new to the group and I'm looking for help. My 5 1/2

> month

> > old twins, Sara and Sam, have plagio, and CIGNA denied payment

for

> > the bands. We got them anyway - what parent wouldn't do anything

> > they could to help their child? - and now we are beginning the

> fight

> > against CIGNA. Thanks in advance!

> >

> > Gail

> > , Texas

[Guest guest]

Gail:

I just searched our group archive & found the message from the mom

who beat Cigna: I've copied & pasted it below:

Debbie Abby's mom DOCgrad

MI

From: " owensmom42 " <owensmom42@...>

Date: Wed Apr 3, 2002 9:05 am

Subject: WE FINALLY BEAT CIGNA!!!!!!!

ADVERTISEMENT

Hi all- First of all thanks for all the support! We got a call from

the external review company MCMC this morning to tell us they

reversed Cigna's decision to deny our DOC band. Cigna still hasn't

called officially yet but I am thrilled to say the least. The

decision was made yesterday which was also Owen's 1st Birthday and

what a great present the $3k is!!!! I am very willing to help anyone

else fight Cigna so please feel free to email me. Thanks again and

YIPEEEEEEE!!!!!!

mom to Owen 4/2/01 banded 12/5/01

[Guest guest]

Hi Gail- I just emailed you personally with more specific details,

but I thought I would put a post here too just in case. In my

experience you have to fight Cigna ( and any insurance) until the

end. We presented extremely strong literature and arguements all the

way through the appeals process but it took the external review board

( MCMC is who we used) to overturn the denial. NO insurance company

is going to give in unless you force their hand so stick with your

fight and don't let them scare you off. There are lots of us out

there to help and offer encouragment when you are feeling frustrated.

I hope that the more of us that fight and win will help make this

easier for other families that come after us. If you or anyone else

has additional questions please feel free to email me. Hang in there

and don't let them get you down!

mom to Owen 4/2/01 banded 12/5/01

> Hello, I'm new to the group and I'm looking for help. My 5 1/2

month

> old twins, Sara and Sam, have plagio, and CIGNA denied payment for

> the bands. We got them anyway - what parent wouldn't do anything

> they could to help their child? - and now we are beginning the

fight

> against CIGNA. Thanks in advance!

>

> Gail

> , Texas

[Guest guest]

Thanks, . I really appreciate the words of advice and

encouragement on beating CIGNA. Sam and Sara have been in their

bands since April 1st, and I'm already seeing improvements. I am

still amazed that insurance companies can be so blind to the impact

this can have in a childs life.

Gail

> Hi Gail- I just emailed you personally with more specific details,

> but I thought I would put a post here too just in case. In my

> experience you have to fight Cigna ( and any insurance) until the

> end. We presented extremely strong literature and arguements all

the

> way through the appeals process but it took the external review

board

> ( MCMC is who we used) to overturn the denial. NO insurance company

> is going to give in unless you force their hand so stick with your

> fight and don't let them scare you off. There are lots of us out

> there to help and offer encouragment when you are feeling

frustrated.

> I hope that the more of us that fight and win will help make this

> easier for other families that come after us. If you or anyone

else

> has additional questions please feel free to email me. Hang in

there

> and don't let them get you down!

>

> mom to Owen 4/2/01 banded 12/5/01

>

[Guest guest]

Thanks, . I really appreciate the words of advice and

encouragement on beating CIGNA. Sam and Sara have been in their

bands since April 1st, and I'm already seeing improvements. I am

still amazed that insurance companies can be so blind to the impact

this can have in a childs life.

Gail

> Hi Gail- I just emailed you personally with more specific details,

> but I thought I would put a post here too just in case. In my

> experience you have to fight Cigna ( and any insurance) until the

> end. We presented extremely strong literature and arguements all

the

> way through the appeals process but it took the external review

board

> ( MCMC is who we used) to overturn the denial. NO insurance company

> is going to give in unless you force their hand so stick with your

> fight and don't let them scare you off. There are lots of us out

> there to help and offer encouragment when you are feeling

frustrated.

> I hope that the more of us that fight and win will help make this

> easier for other families that come after us. If you or anyone

else

> has additional questions please feel free to email me. Hang in

there

> and don't let them get you down!

>

> mom to Owen 4/2/01 banded 12/5/01

>

[Guest guest]

and Jane,

I am in the Dallas area, so I am interested in the lawyers name.

I just hope it doesn't come down to that.

We were given 2 reasons for denial. The first is that banding

is " considered experimental/unproven, and thus not a covered

benefit. " The second reason is " there is no evidence of a functional

impairment requiring intervention " and they consider it a cosmetic

procedure. I'm in the process of gathering documentation to argue

both these reasons, so if anyone out there has anything to add,

please let me know.

Gail

> Interestingly, Where in Texas are you? I actually have been in

> touch with a lawyer in Dallas, Texas that was VERY EFFECTIVE in

> getting UHC to pay for another girl in Texas. This could be very

> helpful to you. Let me know if you are interested in his name.

> and Jane

[Guest guest]

Niki,

I was looking at the home page with my 2 1/2 year old daughter

and she said, " look mommy, it's Sammy and Sara " . She thought your

babies were our babies. It was so cute. I guess it's difficult to

differentiate at that age. I haven't had a chance to decorate their

bands yet, so I'm open to suggestions. I like how you included pink

and blue distinguishing colors. They have been in the bands since

April 1st and I am already seeing progress.

Gail

P.S. I have already heard from .

> Hi Gail and welcome to our group, and congrats on your twins! I am

> also the proud mommy of twins, both of whom needed bands for thier

> plagio (those are my cuties on the plagio homepage!) We just had a

> member finally get Cigna to pay after going through an external

> review. Hopefully , Owen's mom, will chime in here and let

you

> know about her experiences with CIGNA.

>

> We look forward to getting to know more about you and your babies.

> Do you have the bands already? What kind of bands are they

getting?

> Good luck with Cigna, and again welcome to the group!

>

> Niki

> Kaylie & Danny (STAR grads)

> Phila., PA

>

> --- In Plagiocephaly@y..., " momofivftwins " <howieandgail@a...>

wrote:

> > Hello, I'm new to the group and I'm looking for help. My 5 1/2

> month

> > old twins, Sara and Sam, have plagio, and CIGNA denied payment

for

> > the bands. We got them anyway - what parent wouldn't do anything

> > they could to help their child? - and now we are beginning the

> fight

> > against CIGNA. Thanks in advance!

> >

> > Gail

> > , Texas

[Guest guest]

Debbie,

Thanks for pointing me to the " help " folder. I'm still figuring

out all the benefits of this group.

We are in the DOC band (11 days and counting) and they are doing

great. They don't mind them at all. They seem to play with each

others band - they grab on and pull each other closer.

Gail

> hi Gail & welcome!

> We're glad to have you. Like Niki replied, we recently had a mom

who

> fought & fought with Cigna to get her son's band covered. They

> finally did pay! I hope she'll help you & give you good advice on

> how to get them to pay. On what grounds did they deny coverage?

> Also checkout our " files " section, then the " help " folder,

> then " insurance issues " ..I think there is some Cigna info in there.

> Are they in the DOCband? They've started at a great age & I'm sure

> you'll get very good & fast improvement.

> Please keep us posted on their progress as well as your ins. fight.

> Welcome again.

> Debbie Abby's mom DOCGrad

> MI

>

[Guest guest]

In a message dated 04/11/2002 8:55:22 PM Central Daylight Time,

owensmom42@... writes:

<< We presented extremely strong literature and arguements all the

way through the appeals process but it took the external review board

( MCMC is who we used) to overturn the denial. >>

We had an identical experience. We went through every appeal level including

a face to face, but it took the external review board to overturn the denial.

Hang in there and don't give up - they're counting on you to do that!!

Marci

[Guest guest]

Gail -

I will be speaking with the atty on Tuesday. He is looking into the

possibility of a federal class action lawsuit against UHC. I will

ask him if CIGNA can be included as well. It seems they are a big

offender too!

Basically what was talking about is that it seems if you have

an atty write a letter to your insurance company, they will pay

(from the attys previous experience). Most people give up without

getting an atty involved because you could end up spending more

money in atty fees than the amount of the claim if it goes to

trial. The insurance companies know this, so they are willing to

gamble and deny claims. Most people don't fight to the bitter end

and give up long before the external reviews. If you already have

an atty involved they probably will just pay the claim to avoid the

potential PR nightmare and then paying their own legal fees on top

of having to pay the claim out on the end. Has anyone actually gone

all the way to court with their insurance company? My guess would

be no because the insurance company would realize they would pay

more in their legal fees than the cost of the claim, so they would

settle the claim and save the cost of those legal fees. Does this

make sense?

I will let you know what I hear next week.

Dane's mom (DOC Band)

--- In Plagiocephaly@y..., " momofivftwins " <momofivftwins@a...>

wrote:

> and Jane,

> I am in the Dallas area, so I am interested in the lawyers

name.

> I just hope it doesn't come down to that.

> We were given 2 reasons for denial. The first is that banding

> is " considered experimental/unproven, and thus not a covered

> benefit. " The second reason is " there is no evidence of a

functional

> impairment requiring intervention " and they consider it a cosmetic

> procedure. I'm in the process of gathering documentation to argue

> both these reasons, so if anyone out there has anything to add,

> please let me know.

>

> Gail

>

> > Interestingly, Where in Texas are you? I actually have been in

> > touch with a lawyer in Dallas, Texas that was VERY EFFECTIVE in

> > getting UHC to pay for another girl in Texas. This could be very

> > helpful to you. Let me know if you are interested in his name.

> > and Jane