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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 05-25-2008, 12:36 PM
ChainedJane ChainedJane is offline
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Hi all,

Just an FYI that since CIGNA denied my CADR my lawyer found out that the doctor (Rudolph Cane Jr.) that denied it is just an internist...he doesn't know squat about neuro! He is also the Medical Director at CIGNA

So make sure that you demand a specialist look at your claim. The insurance commision and most insurance companies bilaws state this should be the case!

Janey

P.S. A good CC for your appeal >
Dick Salmon, M.D., PhD
Senior National Medical Director
CIGNA HealthCare Medical Management
900 Cottage Grove Road, Routing S208
Hartford, CT 06152
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*c/6-c/7 herniated disc /pinching nerve causing extreme and radiating pain in back-neck and nubness in left arm and compressing spinal cord from 13mm to 6 mm- cervical steriod injections-physical therapy-lots of meds-*

CIGNA insurance revoked my F
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  #2  
Old 05-26-2008, 06:52 PM
JL JL is offline
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Hi Janey,
How did they cancel your procedure two minutes to go? Your reference for "a good CC for your appeal" I don't get it. Is this a pro-adr Dr. or is this CIGNA? Did you mean 900 Cottage Grove Rd. Bloomfield, CT because there is not a Cottage Grove Rd. in Hartford CT. I am not being picky, just want to inform all that from my experience,
I did not find any goodness on Cottage Grove Rd. in Bloomfield, CT. Monkey Man Dr. Aris Yannopolous is Orthopedics Associates of Central CT located at 510 Cottage Grove Rd. Bloomfield, CT and he is a real lying loser.

Workers Comp tried to send me to another Cottage Grove Ortho, a Dr. Schaffer for IME and the guy turned out older than dirt, retired and his last surgery was a hang nail in 1950, so I was informed. I went and paid cash for my surgery before my appointment with him. His office was arrogant and snotty.

Your situation has to be a big conflict of interest that someone must be able to help you solve.

In the end I finally found good, but not without big doses of bad for a long time. It doesn't have to be that way, it is not suppose to be either.

We may be in the same backyard, so don't hesitate to contact me if I can be of any help. Bill
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Discography 2003 DDD
10 yrs. chiropractic
6-14-05 L4/5 & L5/S1 Prodisc Yale New Haven CT Dr. James Yue
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  #3  
Old 05-27-2008, 02:35 PM
ChainedJane ChainedJane is offline
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Hi Bill,

Here is the short and not so sweet of it all. I was scheduled for a Prestige ADR for my c/6-c/7 herniated disc on 4/23/08. The precert went through my insurance which is CIGNA. I was at the hospital and all ready to go into surgery when an admin from the hospitals insurance end called and told my surgeon that CIGNA just called and revoked/denied the claim for the surgery and said they would cover fusion but not Cervical ADR (Prestige). I then got a CIGNA denial letter from Dr Rudolph Cane saying it was experimental. I am appealing and my lawyer just found out that Dr. Rudolph Cane from CIGNA is just an internist and is not trained in Neuro/ortho. He has no clue what the ins and out of the surgery are because he has never been trained, so I was advising people to check up on that "insurance" doc that is denying their claim...make sure he is not just an internist...but a specialist!. The P.S in my message was in reference to Dick Salmon who is the senior med director at CIGNA....and when people send in appeals they need to care execs within the insurance company as well as State Insurance comission execs etc... I was giving Dr. Salmons mailing address incase a CIGNA victim may need it for an appeal...the address I used was for Dr. Salmon on Cignas website. I will have to do some double checking if you think it does not exist and ask CIGNA why they are posting phoney address's! So thanks for the info! Also...I was like you...How can they revoke/deny my claim if they let me get allllll the way almost into surgery...well I find out now that I am a lucky one because...not only can they do that...they can come back AFTER your surgery, after a precert and still deny you. Yeah...aint that a peach! Did you ever get rembursed for your surgery by your insurance?

Thanks,
Janey
__________________
*c/6-c/7 herniated disc /pinching nerve causing extreme and radiating pain in back-neck and nubness in left arm and compressing spinal cord from 13mm to 6 mm- cervical steriod injections-physical therapy-lots of meds-*

CIGNA insurance revoked my F
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  #4  
Old 05-28-2008, 06:27 AM
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Terry Terry is offline
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I'm sorry all but, for those who put a party in power that supports nothing but big business, I say; "Vote Democrat." It's time to get; "SHRUB" out of office and start remembering the little guy. For so long the laws like the new bankruptcy ones that allow credit card companies to hound you to the grave, insurance companies to get away with murder, pharmaceutical companies allowed to market products with impunity, etc. and the list goes on with the abuses of power that have taken place. These people make up the richest Americans in the country and, while they were voting themselves a big pay increase, they axed support for another increase in the minimum wage law. It might hurt big business to have to pay their employees a little more money.

Sorry for the hijack of your thread but this is all relative to the little guy getting squashed by them that makes the rules.

I'm sorry for all of your denials.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
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  #5  
Old 05-28-2008, 06:49 AM
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CindyLou CindyLou is offline
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Uh-oh. We're on a slippery slope here. I, for one, certainly don't won't to see politics hijacking this wonderful forum. Sorry, just my views.
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bicycle accident 6/19/01
2 compression fractures, T12, L1;
vertibroplasty @ above levels, 9/15/01
4/06 hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. B., 3 levels; L3-6
7/2/08 ALIF of L6-S1
7/30/08 Removed bone cement.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion.
3/10/09 right SI Joint Fusion; seeing light at end of tunnel, for first time in 8 years!!
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  #6  
Old 05-28-2008, 11:26 AM
ChainedJane ChainedJane is offline
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Hey Bill,

I doubled checked the address I gave and here is the address at Cigna's site and it is the same as I gave above.
http://www.cigna.com/customer_care/healthcare_professio...isory_committee.html

Here is the link to this address on google > http://maps.google.com/maps?q=900 Cottage Grove Road Hartford, CT 06152

When I called Cigna this is the address they gave me as well....so are you sure it doesn't exsist before I go get nasty with them and demand the right address....because I really need the proper address for my appeal! I live in MO so I am not local to go there and check it out.

Thanks!
Janey
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*c/6-c/7 herniated disc /pinching nerve causing extreme and radiating pain in back-neck and nubness in left arm and compressing spinal cord from 13mm to 6 mm- cervical steriod injections-physical therapy-lots of meds-*

CIGNA insurance revoked my F
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