[Kelly4ADR]

I'm sorry you are dealing with this! It seems like insurance can throw out terms on a whim for basis of denial. In my appeals with Aetna, I am picking apart their terms and definitions. I have some articles and one court case where Aetna had to abide by certain guidelines for using "medically necessary". I don't know how the grievance process works for Cigna, but in my appeal I am requesting Aetna provide answers to a long list of questions I have on their determination process, definition of terms and actually give specifics on who determined and how it was determined "not medically necessary and experimental/inverstgational."

It shouldn't be, but it seems that it is, that if our DRs say its necessary, and the insurance says it isn't, insurance wins.

I wish there was a way for all insurance companies to have clearly defined definitions that are standard across the board. While your case is especially complicated, it just isn't right that some receive coverage and some don't.

Did you get in writing the approval? At my massage clinic, I have had sessions covered for clients who didn't even have massage as a benefit because someone at the ins. Co made a mistake and said it was covered. They were forced to honor it.

Hope this is somehow helpful.