Guest guest Posted December 19, 2003 Report Share Posted December 19, 2003 Mark, We had a fully self funded plan, the employer did not want to help much we had already gone through 2 appeals and the Texas Board of Insurance is the reason I won my case!!!!!!! I know they are not supposed to get involved but if your employer does not tell them to butt out you might have a chance, I'm not telling you what to do I just would like to see all the Cigna people get thier money back!!!!! good luck. The rep with the Texas board name is Kate Burgess........ deeman12342001 <deeman12342001@...> wrote: Hi all,Thank you very much to those who provided me with information on dealing with employers' self-funded insurance plans. I found it extremely helpful to hear from others with the same type of insurance and in the same boat as we are. We are sending a letter to the insurance company asking for the exact reason for the denial and we will go from there with the appeals. Even though we cannot get help from the state insurance bureau (they don't get involved in self-funded plans) it is good to know that in the end the employer has the final say in determining benefits. I guess if the employer refuses then the only option left is to sue them. How messy would that be :-). I really can't imagine the employer refusing the claim, but who knows, they are quite fiscally minded. Guess the next contract negotiation would have to include an extra few thousand dollars to cover the band :-).: is doing extremely well thank you and has grown quite a bit (as the clinician said, "he is growing pretty well for an old man"). He has been banded 10 weeks but we haven't discussed a time frame yet, maybe I will bring it up at the next appointment. Speaking of getting done before too much snow falls, too late!!! We got 27 inches last weekend and I guarantee it will stay until April.Thanks again everyone,Mark ('s dad)For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2003 Report Share Posted December 19, 2003 Mark, when I originally talked to our employer they said that they could not do anything. When I recieved the letter back from Cigna that they were going to pay, it made reference to a Cigna review board as well as our employer. I don't know if the Insurance Board being involved put a fire under someone's butt or not I just know it worked. I have a letter from the Arizona state Board stating that Cigna had to Pay for the Band under DME I can fax it to you next week if you need it. If you have any other questions let me know. I just know of several woman that were involved with Cigna at the same time I was and they are all getting there money back now with it being paid under DME. deeman12342001 <deeman12342001@...> wrote: Hi ,Thanks for the info on your plan. Interesting that your state board helped. Did they speak to your employer and then the employer overruled the insurance company or how did it all work in your case? We actually live in Maine so in the end I may contact the Maine insurance bureau for help if all else fails (even though, as you say, they have no jurisdiction over this). Very interesting to hear your case. Thanks,Mark> Hi all,> > Thank you very much to those who provided me with information on dealing with > employers' self-funded insurance plans. I found it extremely helpful to hear from > others with the same type of insurance and in the same boat as we are. We are > sending a letter to the insurance company asking for the exact reason for the denial > and we will go from there with the appeals. Even though we cannot get help from the > state insurance bureau (they don't get involved in self-funded plans) it is good to > know that in the end the employer has the final say in determining benefits. I guess if > the employer refuses then the only option left is to sue them. How messy would that > be :-). I really can't imagine the employer refusing the claim, but who knows, they are > quite fiscally minded. Guess the next contract negotiation would have to include an > extra few thousand dollars to cover the band :-).> > : is doing extremely well thank you and has grown quite a bit (as the > clinician said, "he is growing pretty well for an old man"). He has been banded 10 > weeks but we haven't discussed a time frame yet, maybe I will bring it up at the next > appointment. Speaking of getting done before too much snow falls, too late!!! We got > 27 inches last weekend and I guarantee it will stay until April.> > Thanks again everyone,> > Mark ('s dad)> > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2003 Report Share Posted December 19, 2003 Mark, Yes, My address is fine. deeman12342001 <deeman12342001@...> wrote: Hi ,Sorry I missed your post earlier. Thanks very much for sharing your story, I truly appreciate it. I would absolutely love to have a copy of that letter, might help especially when it comes time to ask the employer to overrule the insurance company. We will be away until the 29th, should I e-mail you with a fax number? If so, is it your e-mail where I would send it?Thanks again,Mark> > Hi all,> > > > Thank you very much to those who provided me with information on dealing with > > employers' self-funded insurance plans. I found it extremely helpful to hear from > > others with the same type of insurance and in the same boat as we are. We are > > sending a letter to the insurance company asking for the exact reason for the > denial > > and we will go from there with the appeals. Even though we cannot get help from > the > > state insurance bureau (they don't get involved in self-funded plans) it is good to > > know that in the end the employer has the final say in determining benefits. I guess > if > > the employer refuses then the only option left is to sue them. How messy would > that > > be :-). I really can't imagine the employer refusing the claim, but who knows, they > are > > quite fiscally minded. Guess the next contract negotiation would have to include an > > extra few thousand dollars to cover the band :-).> > > > : is doing extremely well thank you and has grown quite a bit (as the > > clinician said, "he is growing pretty well for an old man"). He has been banded 10 > > weeks but we haven't discussed a time frame yet, maybe I will bring it up at the > next > > appointment. Speaking of getting done before too much snow falls, too late!!! We > got > > 27 inches last weekend and I guarantee it will stay until April.> > > > Thanks again everyone,> > > > Mark ('s dad)> > > > > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2003 Report Share Posted December 22, 2003 Mark, What is your fax number? deeman12342001 <deeman12342001@...> wrote: Hi ,Sorry I missed your post earlier. Thanks very much for sharing your story, I truly appreciate it. I would absolutely love to have a copy of that letter, might help especially when it comes time to ask the employer to overrule the insurance company. We will be away until the 29th, should I e-mail you with a fax number? If so, is it your e-mail where I would send it?Thanks again,Mark> > Hi all,> > > > Thank you very much to those who provided me with information on dealing with > > employers' self-funded insurance plans. I found it extremely helpful to hear from > > others with the same type of insurance and in the same boat as we are. We are > > sending a letter to the insurance company asking for the exact reason for the > denial > > and we will go from there with the appeals. Even though we cannot get help from > the > > state insurance bureau (they don't get involved in self-funded plans) it is good to > > know that in the end the employer has the final say in determining benefits. I guess > if > > the employer refuses then the only option left is to sue them. How messy would > that > > be :-). I really can't imagine the employer refusing the claim, but who knows, they > are > > quite fiscally minded. Guess the next contract negotiation would have to include an > > extra few thousand dollars to cover the band :-).> > > > : is doing extremely well thank you and has grown quite a bit (as the > > clinician said, "he is growing pretty well for an old man"). He has been banded 10 > > weeks but we haven't discussed a time frame yet, maybe I will bring it up at the > next > > appointment. Speaking of getting done before too much snow falls, too late!!! We > got > > 27 inches last weekend and I guarantee it will stay until April.> > > > Thanks again everyone,> > > > Mark ('s dad)> > > > > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
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