Re: Did anyone get Cigna to cover speech for apraxia?

[Guest guest]

What state are you in? I am in CT and we had Cigna and they denied speech

coverage...we ended up dropping Cigna and picking up BCBS but were still denied

until we got the states healthcare advocate involved and we ended up winning our

2nd level appeal. We also just won our 2nd level appeal regarding OT. If you

have the benefit in the policy, contact your states healthcare advocate and

states attorney general and get them involved.

lauren baron <laurenrbaron@...> wrote: I am fighting with my

insurance company for months now. We were denied again after our second appeal.

So frustrating!!! I feel it should be covered based on our policy but we keep

getting denied, even with a lot of supporting documentation. Just wondering if

anyone has won this fight!

__________________________________________________

[Guest guest]

Good to know! Thanks. I will do that. We are in NJ.

wendy mazza <wendybird115@...> wrote: What state are you in?

I am in CT and we had Cigna and they denied speech coverage...we ended up

dropping Cigna and picking up BCBS but were still denied until we got the states

healthcare advocate involved and we ended up winning our 2nd level appeal. We

also just won our 2nd level appeal regarding OT. If you have the benefit in the

policy, contact your states healthcare advocate and states attorney general and

get them involved.

lauren baron <laurenrbaron@...> wrote: I am fighting with my insurance

company for months now. We were denied again after our second appeal. So

frustrating!!! I feel it should be covered based on our policy but we keep

getting denied, even with a lot of supporting documentation. Just wondering if

anyone has won this fight!

__________________________________________________

[Guest guest]

I had Cigna a few years back, and we did get coverage for speech. I remember

speaking to someone with a medical background (could be a nurse), who said

they had to fax my doctor's evaluations and slp's evaluation to Cigna's

pediatrician who made the final decision. They did say that typically the answer

is

no, but they would fax the paperwork. I just made sure I did not speak to the

people who answer the phones at Cigna. I spoke to the department that

doctor's call for precertifications on operations, etc. In fact, I think I just

called that number even though I am not a physician, and just apologized but

wanted the correct information.

I am from NJ. Carolyn

************************************** See what's new at http://www.aol.com

[Guest guest]

Interesting! They denied us twice and then offered us a teleconference with a

new group of appeals commitee members (including a pediatrician!) who would

reconsider the case. My son's SLP was on the call with us and we presented our

case. This doctor did not ask a single question and quickly sent out a letter

stating speech was not medically necessary. Ugh!!! I'm not giving up though.

aigjr@... wrote: I had Cigna a few years back, and we did get

coverage for speech. I remember

speaking to someone with a medical background (could be a nurse), who said

they had to fax my doctor's evaluations and slp's evaluation to Cigna's

pediatrician who made the final decision. They did say that typically the answer

is

no, but they would fax the paperwork. I just made sure I did not speak to the

people who answer the phones at Cigna. I spoke to the department that

doctor's call for precertifications on operations, etc. In fact, I think I just

called that number even though I am not a physician, and just apologized but

wanted the correct information.

I am from NJ. Carolyn

************************************** See what's new at http://www.aol.com

[Guest guest]

That is good advice, but from my own dealing with Cigna, I think it is more

that they will not permit speech therapy unless it is a condition caused by

something the child was born with, and there is documented proof of that.

Otherwise, they typically say it is a developmental problem that will work

itself

out. It is a sad situation. Carolyn

************************************** See what's new at http://www.aol.com

[Guest guest]

After 10 months of fighting with Cigna (I work in NY and live in NJ) and

meeting my out-of-network deductible, Cigna has finally reimbursed me for

out-of-network speech therapy for my daughter. I believe the reimbursement

was a result of the policy being changed at the request of the firm I work

for (not because of me) because from what I've been told by Cigna, as well

as other insurance companies, reimbursement for any procedure depends on

how the policy is written for the particular firm or company requesting

insurance coverage for their employees.

Joanne Obara

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[Guest guest]

I think that the original poster needs to contact their company's

human resources department. It is possible that the speech is being

denied because their employer did not purchase a policy that would

cover the therapy. So... before appealing again and again....see what

the employer paid for. If they didn't cover this service for their

employees see if they will give your child an over-ride. My

husband's employer gave us one.

If your employer didn't pay for such coverage no amount of appeals

will help. So turn your attention to appealing to the employer to

get them to up your child's coverage.

Kris

The Knitting Wannabe http://knittingwannabe.typepad.com

Sonny & Shear: The I’ve Got Ewe, Babe Yarn Shop

http://www.sonnyandshear.com

On Oct 30, 2007, at 3:33 PM, Joanne Obara wrote:

> After 10 months of fighting with Cigna (I work in NY and live in

> NJ) and

> meeting my out-of-network deductible, Cigna has finally reimbursed

> me for

> out-of-network speech therapy for my daughter. I believe the

> reimbursement

> was a result of the policy being changed at the request of the firm

> I work

> for (not because of me) because from what I've been told by Cigna,

> as well

> as other insurance companies, reimbursement for any procedure

> depends on

> how the policy is written for the particular firm or company

> requesting

> insurance coverage for their employees.

>

> Joanne Obara

>

> ==========

> This e-mail (including any attachments) may contain information

> that is

> private, confidential, or protected by attorney-client or other

> privilege.

> If you received this e-mail in error, please delete it from your

> system

> without copying it and notify sender by reply e-mail, so that our

> records

> can be corrected.

> ==========

>

>

>

[Guest guest]

We have CIGNA. We were denied once. Then I submitted the evaluation from

the developmental pediatrician which diagnosis dyspraxia and recommended

the ST for an oral motor planning disorder (in the fine print of our

policy, it said apraxia wasn't covered so I asked the doctor not to use

the word " aprxia " ). We've since been covered. Good luck.

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