Re: Insurance Denial-Cigna

[Guest guest]

Hi and welcome to the group. We have Cigna insurance too and they

paid for BOTH of my son's doc bands at 90%. Cigna requires

measurements and a letter of medical necessity. I believe they will

cover for a doc band if the assymetry is 12mm or more. Cranial Tech

will take the measurements and submit that along with the letter

(from your ped or specialist) and other paperwork to Cigna. Cigna

will give you a predetermination within 30 days which will tell you

if they will pay for the band or not. They will not " pre-certify "

which means that if you are prepared to pay even if they do not

reimburse, you can go ahead with the casting and not lose benefits.

In our case (both times), we had Cranial Tech do the measurements,

submit the paperwork, and went ahead with the casting. We paid

Cranial Tech $500 up front and were reimbursed the difference when

Cigna made the payment. Both times Cigna paid within a month. In my

experience with Cigna, you usually get a different answer from each

rep you speak to. My best advice is to go to CT and have them submit

everything for you. The only reason I can think of for denial is if

your son's measurements aren't " severe " enough for them. Do you know

what his assymetry is? I hope this helps, please let us know if you

have any more questions, or e-mail me if you want. Good luck!

& Aidan in CT

16 months old, doc band #2 11/9/04

>

> I am looking for help. My son is 6 mos old and diagnosed with

> positional plagiocephaly. Our insurance company, Cigna, reported

that

> there is no coverage for a DOC band and denied the request. His

> pediatrician completed a doctor to doctor with the medical director

> and the denial was upheld. Please let me know if there is anything

I

> can do to push this through. The poor little guy has been through

so

> much in his short life. Any help would be appreciated.

>

> Thank you.

[Guest guest]

Hi. I think it depends on each individual insurance policy. Cigna

has many types of policies and in one policy it may be covered and

in another it might spell out " cranial banding not covered. "

Hopefully yours doesn't state this. You can request from the

insurance company or an HR person at your or your husband's company

a copy of the insurance policy and ask the Cigna person to quote

what is stated in the policy that says it wouldn't be covered.

Good luck!

Robin (mom to Owen 7 1/2 mo., plagio, tort)

> >

> > I am looking for help. My son is 6 mos old and diagnosed with

> > positional plagiocephaly. Our insurance company, Cigna, reported

> that

> > there is no coverage for a DOC band and denied the request. His

> > pediatrician completed a doctor to doctor with the medical

director

> > and the denial was upheld. Please let me know if there is

anything

> I

> > can do to push this through. The poor little guy has been

through

> so

> > much in his short life. Any help would be appreciated.

> >

> > Thank you.