Independent Review

I have a friend who is at her wits end with Cigna. She requested an external review with Cigna and has heard nothing from them yet. She wants to send a request directly to an independent review agency. Can she request and independent review directly or does she have to go through Cigna? Also, does anyone have any addresses or contact information for any independent review agencies??? Please help!

Having just recently requested external review, I believe that you have to go thru your insurance company. But don't let that scare your friend. Each state that requires it's member insurance companies to offer external review has a listing of those independent review orginizations certified or authorized by the state department of insurance to conduct external reviews. If a reasonable time has passed since your friend requested external review, and she has not heard anything, I would reccomend that your friend contact her state department of insurance and request that they contact her insurance company on her behalf and find out the status of her external review. You would be amazed how fast an insurance company will respond to a state department of insurance inquiry. When I received my first denial, I made a complaint to the Indiana Department of Insurance the same day I filed my appeal letter to my insurance company. In fact, on my appeal letter, I CC'd (closed copy) the commisoner of the Indiana department of insurance. To be perfectly honest, I did this so my insurance company would know that I would not take denial lying down and that I was prepared to fight. Sort of a shot across the bow. Sadly, I have learned through this forum, and from my own experiences, that insurance companies expect you to quit once you are denied. I also have sadly learned that most people who are denied the first time do indeed give up. When I called my Surgeon's office to tell them I had been denied in appeal, I asked the office manager what kind of experiences had their patients had with external review? The office manager replied, " Tim, I don't really know as we have never had a patient take it that far..." Never, never, give up! All the best, Tim R.

She needs to follow through with the appeals procedure. Has she called Cigna to find out if they've sent the review out yet? Cigna uses Hayes and at least one other Independent Review Organization. The good news is, she will probably get approved on the external review. Tell her to call John Coyle office, at Cigna's home office in Philadelphia. He is the VP of Health Claims. She can file a complaint with his office to get things moving. Fight the good fight! Roberta