Re: Dr's that perform fresh muscle biopsy

February 14, 2004

Hi, I'm in Cigna PPO also. Cigna is my company's insurance

administrator as we are self insured. I thought Shoffner was out of

network. We had a frozen biopsy done and I regret it. I even asked

wasn't it best to do it fresh and the geneticist said frozen was

fine. But now I wish I had pushed more. But, my son was having

surgery anyway (that's why we did it) and so I guess frozen was ok.

It was actually billed via Quest though Athena labs did it. I was

under the impression that Quest labs had to do all Cigna lab work. If

Quest doesn't do it (as the case with the muscle tests), then they

have to get approval via Quest. The geneticist's nurse went way out

of her way to ensure everything was set up. She called and got the

Quest approval codes and everything because the tissue had to arrive

at Athena within 24 hours. Obviously, that couldn't be done if you

have to send it to Quest first (like you do blood). I would assume

that the same holds true for fresh muscle tests. Obviously, if that

is to be done, then you must go to a place that will do the tests -

regardless of where that is. What do they care where you do it? You

don't have to have approval for tests if you're in a PPO. Ask for a

case worker from Cigna if you're having problems with this.

Also, if you find Shoffner is on Cigna network, please let me know.

> Hi everyone! I have only posted here once but I need some help,

> please! I am having a heck of a time getting my insurance company

to

> pay for Hailey's much needed biopsy. They keep throwing the fact at

> me that there is more than one doctor (neurologist or geneticist)

> within a thirty mile radius of our home (Piedmont, SC). I would

like

> to call them back and say there are only a limited number of docs

> that perform the fresh tissue biopsy in the US. Does anyone know of

> an exact number?

> I guess I should throw in the fact that we are trying to get in to

> see Dr. Shoffner. I will gladly travel anywhere to have this done

as

> long as it is going to be paid as " in network. " (I am starting to

> hate that term)

> Does anyone know who is in Cigna's PPO network that performs these

> biopsies?

> Thanks for any help you can provide!

> Sharon, mom of Hailey, 2 1/2, undiagnosed, suspected mito

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