Patient Advocate - TES

[admin]

We were denied by Cigna Health to use e-stim (TES unit) for my son's BPI. The insurance company states that there is no proven evidence to use TES for the treatment of BPI.

An appeal was sent by our doctor, and we are still waiting for their reply. Meanwhile, we want to get ready to get some help from Patient Advocates.

Someone posted before about hiring a patient advocate specifically for this matter. Please share with us the name of the patient advocate, and contact information.

Any other patient advocated related information will be greatly appreciated. Thanks!

Jenny

[browning93]

Jenny, we had Cigna Healthcare until this past year and I had to have the ortho who did our daughters primary surgery write them 3 letters and help with the appeals process. It took me 13 months to get it but they approved it and paid for the whole thing. Do you have a case worker? That's one of the first things you need to get your pediatrician to get for you so you can call them yourself and deal with the same person everytime and send all your letters to.One of the big things that helped was the doctors letters basically stating that if they paid for the surgery and invested all that money on it, then it was preposturous to not pay for the followup treatment. She also sent them alot of info from Mayatek on TES treatment. I believe these articles are available on the internet. Good Luck!! LeeAnne

[francine]

jenny - there's some information about this on the estim page here...

http://www.injurednewborn.com/maia/estim.html

Also the patient advocate link that I have on the site is

http://www.patientadvocate.org

You may also want to contact Leslie McKibben at lmpt@worldnet.att.net - she is a PT and also a TES instructor and she may have some valuable ideas on how you can fight this.... actually it is her comments that I have on my estim page.... but I really love Lee Ann's post - she made some really good points.

There are also foundations that may want to purchase the machine.....check with your local Early Intervention or with Easter Seals to see if they have a list of foundations or if they themsevles can help. If Shriner's are in your area, they may be able to help (if they are a mayatek certified therapy center). Check with your religious community (if you belong to one). Just use all the resources you can find. And don't forget that Mayatek has a rent-to-own payment plan you can set up to pay over time.

No proven evident....gosh - wish they could just see the difference that Maia got with it. Within six weeks her robotic movement became so fluid. It really helped her! I guess this is someone else who has to publish! You should communicate this to Mayatek - maybe if we pressure them they'll do a bpi study and publish it? It would certainly help a whole load of us out!

-francine

[francine]

also check the resources page on my site

http://www.injurednewborn.com/resources.html

go to the bottom in the misc section - there are some helpful links in that grouping, too.

-francine

[francine]

Jenny - here is a quote from Tina (TNT) from another post about SSI.... this kind of fund might help you purchase the TES unit??

"....like a program at our local children's hospital that has a fund of up to $1,000 / year / child to help cover things that insurance doesn't cover and I'm hoping to get alternative forms of therapy covered (for ex. Kindermusik, yoga therapy, massage therapy, hippotherapy, etc.)..."

[browning93]

I mshould add I was just trying to let you know that Cigna has paid for a TES machine before, there is no reason why they shouldn't again. Don't give up. If I can find my info on the case worker we had at the time then I'll send it to you. I don't know what state your in so it may not help but can't hurt. LeeAnne

[admin]

Hello Jenny,
I am the Patient Advocate that was mentioned to you. Please feel free to E-mail me with your concerns.

[admin]

Lee Ann,

I just got a letter from Cigna yesterday, I guess we have a case worker now.

If you could find the name of your case worker and let me know, that will be great.

Our appeal processor is Joyce Hall.

Thanks! Jenny

[Ruth]

I too, was refused by my insurance company for the TES unit. I went ahead and ordered it anyway and we are paying for it out of our flex spending account. My insurance company said the same thing, it is experimental and no studies have been done. I hope it helps my son. My therapist and I are going to keep a video record of how he progresses with the theraphy and send it to our insurance company in six months after treatment begins. Hopefully if they see how it has helped they will reimburse us.

[admin]

I posted a message earlier, somehow it did not show up.

Lee Ann: Could you tell me the name of your case worker? We just received a letter from Cigna and have a case worker now. Thanks. Jenny