CIGNA 1st level appeal denial

[Guest guest]

We just received our first level appeal denial. The preapproval was

denied because " the reason for the band appears to be cosmetic " . I

sent them an inch thick packet of data. This letter doesn't even

bring up " cosmetic " and " medically necessary " but says that cranial

bands for PWS (plagio without synostosis)have been reviewed by the

Technical Evaluation Center and do not meet four of their five

criteria. It meets the FDA approval, but says " without any direct

comparative data from well-designed studies on the health outcome

effects of cranial orthosis in comparison to active positioning

intervention or no intervention, the evidence is considered

insufficient to permit conclusions on this technology " . So they

don't have enough untreated, malformed babies to study into adulthood

and see how messed up they really are.

Getting this letter and then seeing the article in the Arizona

Republic about CIGNA paying for massages just makes me crazy!

Anyone else get this " new technology not proven " denial? Any

suggestions. I've asked our specialist and CT to write responses and

have scheduled a second level appeal.

I'd always heard they can't give you a different reason for a denial

the second time but evidently they do.

Dawn R.

Ft. Laud FL

Mom to