Sunday, January 10, 2010

A Letter to Insurance

Dear Ci.gna,

Yes, you have been my insurance carrier for several years now. I pay out the nose so I can have decent insurance. I do not understand you in any way, shape or form. You so easily pay for some things and fight, deny, fight, deny other things all under the guise that my employer is asking you to do this. I will not take the most recent coverage denial lying down.

We were fitted for a wheelchair back in September. Who WANTS their child to need one (unless they have Munch.hausen by Proxy)? It was a life altering, traumatic experience to realize that my child will need one and come to the decision to get fitted. I find it truly crappy that you send us the paperwork for denial two weeks before we were supposed to get the chair. It is crappier that you sent it addressed to my child. She is only six and does not understand the ins and outs of the insurance BS you put us through (although she might be able to make sense of your nonsense in her world). It is the crappiest that it was right before Christmas.

What part of Spastic Diplegic Cerebral Palsy do you not understand? Yes, she walks. She doesn't walk far or well for long periods of time. We can't make it through the grocery story, let alone Walmarx, the mall or downtown parking to get to dr. appointments with out her needing to be carried or ride (in her stroller which if for babies, she has NO independence in that). You have paid for her Mac.laren Major with insert, her multiple DAFOs, her weekly therapies and numerous dr. appointments.

Yet, you deny her wheelchair for ridiculous reasons. Quotes from the letter:

=The individual does not have a disease process or injury for which weight-bearing and/or ambulation is contraindicated.
=The individual does not have a disease process or injury that precludes use of the lower extremities
= A seat width and/or depth of 14 inches or less is not recommended

Again, what part of Spastic Diplegic Cerebral Palsy is not understood??? As far as the smaller seat width---- she is a small child! DUH! DUH! DUH! They also do not want to give us a light weight wheelchair cause the caregiver can push a standard chair. I can, but she is, once again, a small child and we are hoping she can gain independence by maneuvering herself.


As I said before, I will NOT take this lying down. You ruined my Christmas and have started off my New Year on a sour note. I guess filing multiple back injury claims will help? I am filing every appeal you give me, already at the third level. I have gotten the CEO of my hospital involved (yes, I work at a hospital that has multiple people disbelieving this as well). A basic pediatric wheelchair is NOT a luxury for us, it is a necessity.

Ci.gna Insurance, you suck! F*@k you very much for you inattention to this matter.

Sincerely,
Meghatron's Mom

11 comments:

Candace said...

YESSSSSSSS! I think we should all write letters and mass email them to all the insurance carriers with death threats! Just kiddin'! But I feel you! It took over 10 months of fighting to get Faith's chair! The first denial letter was never sent to us so we sat for two months thinking that everything was a go! They denied it b/c they said they already bought her one! When actually they rented one for 30 days at a rate of $150 (total) months before we even started the paperwork for her wheelchair! Then the second and third attempts- supposedly her paperwork was lost after it was returned to the bottom of the stack at the state medicaid office b/c THEY misread the rental letter! I was ready to strangle someone! Explain how you transport a nonwalking 50 lb child with no wheelchair!

j said...

i HATE insurance companies. they are ruthless and cunning. i am so sorry that everything has to be such a fight for you. can you join blog frog. they are a great community that might be able to help you.

pixiemama said...

I wonder what the deal is with insurance and wheelchairs. When we brought Reilly home from his brain surgery, he couldn't walk across a room unassisted. I took the script to get him a rental chair, got the chair, used it like crazy the entire summer, returned it when we were done, and was handed the bill because the insurance wouldn't pay. I fought them. I got the rehab doc involved, his PT & OT, his school. I had written documentation from most of the major players in his life. It took 6 months (and a lot of patience from the rental company, who agreed the insurance should cover it) but I finally got the bill paid.

You are so right - don't take it lying down. Also, while you're at it, see how often they will pay for a new chair. If they only buy one every 5 years, that might be why they are fighting the size.

xo

therextras said...

This is so wrong, MM. I can't help but think the DME did a poor job of submitting the paperwork. Hoping you will post an update soon. Barbara

Erin said...

Good God. What a bunch of dickheads. I'll go run them over for you, in MY wheelchair that took over a year to come through! Although that has nothing to do with Cigna. How bloody ridiculous! I'm sorry Meghan will need a wheelchair, but I'm sure it will give her some great independence. I know it has given me a lot!

Angela said...

Don't even get me started!!!!! I am so sorry and to add this on top of everything else :(

I hope approval comes through...keep us posted!

Anonymous said...

Go, Fight, Win!!

Copasetic said...

I'm so sorry, I feel your pain...my little girl is going through the exact same thing right now with CP. Cigna has had me in tears for the last two days (the reason I was searching and found your blog.) Cigna is refusing to pay for anything even physical therapy! My letter also address to my child said it was not a "Medical Necessity." Are you kidding me???! Four specialists are claiming it is but they apparently know more about my situation then the doctor does.

She really needs therapy but we can't afford it (it states therapy is covered in our policy!)

I'm just sick that I can't help my little girl...

MeghatronsMom said...

@ Copasetic:

Do NOT give up! File the appeals. Keep fighting. How old is your daughter? That might make a difference too.

GL. If I can help you in any way, please let me know!

Copasetic said...

She's still little she's only 18 months, so at first I had to come to terms with the diagnosis and then immediately Cigna started denying everything. My policy clearly states that we have 30 sessions a year of physical, speech, and occupational therapy if it's "medically necessary." The doctors have said we are fortunate to have had it diagnosed so early and and if we get her in therapy asap she should be able to walk fine, maybe with just a little limp. But twice now a review panel at Cigna has determined that it wasn't "medically necessary." I can't understand how they can determine that when neurologists say it is?

I'm really hurt and down right now but I'm not going to give up yet. My husbands benefits department is working on it and I will get an attorney if we have to in order to get the benefits in our policy.

I'm American but my husband is from New Zealand. It's sad, but if we have to go through this for many years to come, we have been considering moving there so she will get the treatment she needs and not have to fight it all the time :( Their government will cover everything and the level of care is just as good as ours. We have two other very strong and active infants and I want the impact of this on them to be as little as possible (if I can.)

Your blog is very nice, I've read a few posts. I was thinking it must be therapeutic to get it written down.

MeghatronsMom said...

@ Copasetic:

Have you tapped into your state's early intervention services? We used EI until 3 years then tapped into our private insurance. It might make a difference for you & take off some of your stress. ITA with you, the sooner the better. I believe it made all the difference for MM being able to walk unassisted now.

Keep me posted, you can email me @ meghatronsmom@yahoo.com