The 2004 adventure, archived
Put on Hold…
Date: 8/3/04 at 8:36PM
A Dr. Stewart at Cigna has determined that this surgery ought to be done locally, so he has denied the authorization. A Cigna rep says I can appeal that, and gave me a fax number. She says they must respond within 30 days to an appeal.
30 days.
And what condition will my heart be in by then?
Still holding…
Date: 8/4/04 at 9:24AM
I faxed a 22 page appeal to Cigna this morning. I already had most of the documentation at hand, or on this page, so it’s not as onerous as it sounds.
Then I heard from the surgeon’s office that they may have worked something out.
So here I wait…
The Waiting Game
Date: 8/4/04 at 8:33PM
No word today. I guess I’ll go back to work tomorrow and wait out the 3 days “expedited” appeal process. That’s better than the 30 days, unless I have to appeal the appeal? They wouldn’t do that to me, would they?
I can agree with them on one thing: I shouldn’t have to go 150 miles for this!
On the other hand, it could be worse. It could be out of state…
Word from Cigna
Date: 8/6/04 at 4:58PM
I finally got word from someone at Cigna appeals. They said the appeal has to be done in 15 days, not 30. They also said they’re not treating it as an expedited case (with a response in 72 hours). Why? Because it’s not life threatening. Hmmm.
So we had a talk and I explained the situation with the atrium now enlarged, and the consequences of surgery being put off too long. They agreed to handle it on an urgent basis. They may have an answer by the end of next week. They are now waiting for my records from the doctor and Health Services part of Cigna.
Meanwhile, I’m trying to give my heart a rest and keep from stressing out.
First answer
Date: 8/11/04 at 8:41PM
I heard through one of the doctors that Cigna has denied the appeal. So I called, and the nurse handling it recommended I take it to the second level appeal and send all the documentation I can get, including all the doctor’s records, to expedite the process. I spent part of the afternoon getting records from the various doctors I’ve seen.
Out of curiousity, I looked up the average cost of this procedure in Orlando and locally, using the Florida Health Stats database. The cost is about $70,000 more here than in Orlando for Cigna. Go figure.
But they seem to be convinced there is someone locally with enough experience to do this, so I will try again tomorrow, narrowing my search to doctors affiliated with hospitals which do the highest number of this procedure.
I sure wish Cigna would offer some help, but so far no one there seems to have much information about the doctors in their “network” (at least that’s what they have said so far).
No hurricanes here but…
Date: 8/12/04 at 8:37PM
It seemed like it could have been a hurricane for all the rain I drove through to get to an appointment near Miami. Meanwhile, they tried to call me to tell me the surgeon had left for an emergency with one of his patients at the hospital. I didn’t find out til I got there, then had to turn around and drive back through all the rain. I get to repeat the exercise tomorrow.
I still haven’t officially heard from Cigna about the appeal, so I can’t take it to the next level yet (the instructions are on the letter they sent out). So I am still gathering data and documents in between calling other doctors.
Of the four specialists Cigna gave me today, two actually do adult heart surgery. They need a reality check at Cigna.
The new count
Date: 8/13/04 at 9:19AM
I have come up with a list of fifteen cardiovascular surgeons from Cigna’s provider directory, and have been calling their offices. So far:
So far, I have three appointments, and none of them are on Cigna’s list of cardiovascular surgeons.
