It all started last week with my FIRST call to Cigna about covering Will's DOC band. The nice lady said that our plan looked to cover it and told me to have a nice day. I was satisfied and happily awaited the call from Cranial Technologies saying that they too spoke with insurance and all was good...
NOT!
Two days later, Cranial Technologies called to say that Cigna told them that Will's case was going in front of a nurse board and it could take up to 20 days (business days, of course!) to get an answer. Thus, my SECOND call asking what changed in 48 hours? That lady, not nearly as nice, said that if surgery was not involved, it goes on a case-by-case basis. I wasn't as satisfied as the first call to them, but still hopeful...
UNTIL...
...the next day when Cranial Technologies called back to say that Cigna DENIED the case due to the fact that surgery was not involved. Hunh? It was on!
This not-so-happy "mother hen" called yet a THIRD time, got a supervisor from the appeals department on that phone, and used her teacher voice! Oh, yes I did! I told that lady that I know we don't have 3 plans - so how in the world can I get three different reponses (getting progressively worse, I might add!) every time I called? It's either yes, no, or maybe....NOT ALL THREE! I mean, can I have my pick?
Anyway, I collected myself (in a Bree from Desperate Housewives sort of way) and calmly told her, "Well, mam, since my son's ears and jaws aren't lining up, and his forehead bulges out slightly on one side, leaving a concern in the area of balance, speech, chewing, and vision, $3600 is probably a lot less than you will possibly have to spend on physical & speech therapy, orthodontist work, glasses, and even surgery down the road! But you decide."
Um...she said she'd contact her supervisor and get back to me.
And she did......with a big, fat apology about how the board initially "missed" the clause in our plan that stated, "If surgery is not involved, cranial bands are not covered unless there's a medical need, then it's paid in FULL.
Thank you. :)
9 comments:
God still answers prayers.
YOU GO GIRL!!! That is a huge answer to prayer.
Way to go Mamma Bear!! So proud of you for standing up for him.
Love,
Marji
Way to "cluck", Mother Hen!
You Go GIRLIE!! Those darn insurance people try to get out of covering whatever they can! So glad it worked out!!
PROUD of you for standing up for your little guy!!
i'm glad you got it all taken care of! i love you :)
Cluck,cluck! so proud of you mama hen!
"paid in full"...isn't that just music to your ears?? Ashley and Amanda used to call me a squawking bird (they tried...unsuccessfully...to say I sounded like a bird squawking when they would get in trouble...) I guess now we can officially pass the title on to you. Way to squawk mama!
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