Posted by jimplasticguy on June 30, 2011 at 22:46:37:In Reply to: Insurance Problems posted by Silvergirl on June 08, 2011 at 20:26:52:
Silvergirl,
I have been delaying on writing a planned post here about my experience including tips. I have a lot going on the next few days, but here is an abbreviated note. I tried to post it a few weeks ago and kept receiving some type of system error from the board. The financials are now largely complete and the result was that I received a LARGE refund of my surgery down payment, nearly all of it.
I was successful at obtaining an out of network exception through Cigna in March. What's important is to work the details BEFORE your surgery. Mine ended up being very close, with the approval coming in a week before the surgery.
Key things that I did:
-Requested a "case worker" in Cigna to help me navigate the system. This was a registered nurse who understands the system. She was an angel. I know what you are thinking. Yes, there are good ones working in insurance.
-Proactively worked the system ensuring that I never got a denial letter. In other words, I stayed ahead of it, because my understanding is it is tougher once that happens.Before asking for the exception, I asked them for local, board certified, qualified surgeons. I went to the surgeon they suggested with all my records, history, and the X-Rays / Pictures from Dr. KL and others. After a frank discussion and examination, the surgeon agreed with my decision and to write a letter to the insurance recommending that I continue with Stanford and Dr. KL. Note that I was very careful to not step on this Dr’s ego. I told him why I thought California was best for me (multiple board certifications, history of Stanford pioneering work in this area, etc). I also said that I was certain he was also a capable surgeon. I kept it non-confrontational and more like a brainstorming examination to find my best course of action, even though I knew what I thought that was.
Good luck.
Jim