LeeAnn - TES- Cigna

[admin]

Lee Ann,

Could you share with me the name of the Cigna person who did your appeal for the TES unit? We just got a letter from them, so we have a case worker now. Her name is Joyce Hall.

Thanks, a lot!

Jenny

[browning93]

All I can find is the case workers name Kathy Smyth and we're in Florida. That's been 4 years ago. Anyway, the Cigna person or case worker does not do your appeal, you and your doctor do. The case worker is who you send the appeal letters to and they have to go to their supervisors with the information on your behalf. The more information you can give the caseworker the more she has to work with. In order to get the Mod Quad approved after appealing for 2 years I had to send every medical record I could find on Michaela from birth. Her pediatricians office gave me her whole chart and I sent every record or letter I had from the 3 orthos she's seen, 4 therapists, copies of all evals, etc. Anything you can arm her with will help. Also, if the caseworker we had isn't there or you're in another state, maybe she could check records for October, and November 1998. We received the machine on Oct. 28,1998 but I don't know when they actually paid for it.It was purchased for Hannah Michaela Browning. I don't know if Joyce can legally use this info but I'm giving you permission to go ahead if you need to. Even if you can give her this amount of info it will tell her you know for a fact that they have paid for one before. I can't think of anything else but hope this will help. Let me know if I can do anything else. Thanks, LeeAnne

[admin]

Thanks LeeAnn for the information.
Today I got hold of our case worker. They keep asking us to send peer_reviewed articles, which we have difficulty finding them. My doctor sent in one article that we got from Leslie (TES instructor). That does not seem to be enough for them. Did you guys sent in any articles? If you did and can find it, please give me a copy.

Also they want all the physical therapy notes, evaluation of his function at this point. We need to do that in the next 10 days.

Thanks again! Jenny

[Karrie -- Md.]

We have Cigna health insurance. My son got a FNES machine back in 1999. It was covered 90% by our insurance. We live in Maryland. We never had to fight the insurance company. All they wanted was a letter of medical necessity and a prescription from his doctor. My son is Kyle Landon McDermott, birth date, 12-19-1997.
Karrie

[admin]

Thanks everyone for sharing the information. I am going to call Cigna Health about this. Jenny