[Judy]

I don't know whether anyone will be able to help on this and I apologize in advance this is long:

Fusion and ADR surgery done at the same time. Processed claim for the FUSION only (done overseas). This was back on 12/29/04. They went back and forth until April and decided they weren't going to pay because it was ADR and is experiemental. At this time I explained I did not place a claim for the ADR I didn't even send them the invoice for this. Well they then said they would look at this again and I alos gave a medically necessary letter for the surgery.
They have taped conversations with me a customer rep prior to surgery where they did not say they would not pay for surgery done out of the country and this is another reason they said they would review this again.
Almost ten months later I finally heard from this week and again due to experiemental reason they will not pay. They said if I had the surgery done on two different days they would pay. They claimed they had their lawyer look at everything etc. and they were not going to give me anything in writing to this effect they said I still have the April decision and I can just use this. At this point I was very upset and explained I wanted this in writing so I can start the appeal process and if she really knew their policies she would understand that you only have so much time to appeal and that 6 months would then too late. She also explained the cost of the fusion in the US would be approximately $7500, I said I don't believe you can have any surgery done in the US in a hospital for $7500 and she said they if I can get her the code of a fusion maybe she would then look it up and see. See I belive Cigna screwed up when they did not tell me that overseas was not covered and why would any claim take 10 months to be processed if there isn't something there they don't want me to know. I also asked for all the typed conversations of all my calls since last July. They would look into their company policy and see if it allows them to do this.
Now for the appeal, for the fusion/adr where do I start. I am sure that many people on this board have alot of information or can at least point in the right direction. I think my biggest part of this is some kind of backup of the medically necessary for me to have a combination surgery versus going through two surgies, and where might I get this type of information. Where can I get information on the cost of a fusion?
I know I have a lot of questions and if anyone can help me I would greatly appreciate any information you have. Again I want to go after payment for the fusion only at this point.