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RE: Insurance Appeal

Posted by Mar on 3/05/03 at 17:20 (111921)

I am in the process of a second appeal with CIGNA for the ESWT. The hearing is this Tuesday and I am going to be in on it by phone, if I can ever get through to them at the number they gave me to confirm it!! Does anyone have any suggestions as to what i can say to CONVINCE them to pay? Any help is appreciated. Thanks - Mar

Re: RE: Insurance Appeal

Dr Z on 3/05/03 at 17:22 (111922)

What time is the appeal ? Maybe I can speak for you Mar if I am available or maybe your treating doctor can. Do you know the time of the telephone conversation

Re: RE: Insurance Appeal

Mar on 3/05/03 at 17:30 (111924)

Dr Z -

I will email you the info - thanks!!!:-)))) Mar

Re: RE: Insurance Appeal

Scott Reeves on 3/10/03 at 10:06 (112419)

I was going through the appeal process as well and what may help you is a letter from your place of work (if you do work) stating how it is impacting your job, missed time, etc. Or a representative from your work for the phone conference.

Detailed medical history of everything you have done prior to ESWT
Case studies
How much is ESWT vs. the insurance companies preferred treatment
Time off from work from invasive surgery vs. ESWT (another HR thing)
Potential lost of wages w/ surgery
Success rate w/ ESWT vs. insurance companies preferred treatment

I ended up getting a great price and decided to let the appeal go because many people told me Aetna just doesn't go for it. I had ESWT done a little over a week ago and had surgery on my other foot two years ago for PF.

I was able to return to work without missing any days with ESWT and my recovery, ability to walk, and state of mental health is far better with ESWT than it was with the surgery and being immobile, then crutches, then a walking boot, and a much longer, painful recovery - that only partially worked.

The more emphasis you can put on yourself and your work/life is to your benefit in comparison to the doctor providing the treatment.

Hope that helps.

Re: RE: Insurance Appeal

Mar on 3/10/03 at 16:32 (112465)

Thanks Scott -- Mar