Should I stay or Should I go?

Ok, for Susan and Sheila who had great faith in Dawn I have waited and tried again but I think it may be time for me to find a way to get my stuff transferred somewhere else. I have called her twice this week, once to when I got my letter to see if hers gave more detail and she said she would get hers the next day and call... she didn't so I called her yesterday and she said she would call them and then call me with what to do next... she didn't. I am trying but it is over a week since denial and I don't know what to do and I am under enough stress here. I don't feel my best interest is at heart. I may be impatient but I cannot just sit here and twiddle my thumbs like nothing is wrong and let a month go by still not knowing what to tell my PCP and how to fix it. I am starting to think I will never get anywhere with this if I just wait on her. Is there noone else who can help me with this? Someone has to know what to tell me to do? I am gonna call Vandy today and talk to someone there.... Any suggestions?

Hi Melissa. I am sorry you are having so many problems finding out what the next step is. I would suggest Vandy but they were the same way. Actually, I LOVE my surgeon at Vandy and would recommend him to anyone (Dr. Torquati) but I had a lot of problems getting in contact with the people there who handles the files and insurance there when I was trying to get approved (adn after I was denied at first). Honestly, I think you are going to have that same problem wherever you go. They are just so busy with so many people that when a denial comes through, they just wait until they receive the info from the insurance instead of calling. My suggestion is to keep trying. If you change, you will just have to go through the process of going to the seminar and waiting for an appointment and then resubmiting agian. One way, I was able to finally do it with vandy was email. So, if you have an email address for Dawn, try to email her. She may respond quicker than a phone call. Maybe you can try and call your insurance co agian. Maybe one time you will get someone nice there who will answer your question. Try to be as nice and vulnerable and desperate as you can and maybe you can get someone who will help you. I am surprised you haven't received the letter for the denial in the mail yet by now. I guess you have learned that this is not a short time process. It is a LONG process. Keep us updated on how it is going. I hope you can get answers today so you don't have to worry about it all weekend. Misty

The letter was generic... we sent them six months of doc supervised but they said we did not satisfy the requirement so I called Dawn and she said she did not know and when I call Cigna they won't say specifically what was wrong with it they say call the doctor's office and it is a vicious circle for me. If the doctors are doing something that is not right we can't change that because we don't know. I honestly think she don't read the stuff before she sends it in she just sends it so if something was documented incorrect or was missing you would think the ones who do this for a living would tell us but you are probably right that changing would delay it and maybe I should just let what happens happen. I keep trying to be pursistent and all I do is make them irratated that I am calling again. I wish I knew what now cause my PCP is seeing me weds. and I don't even know what to tell him. Now my sister who is at the beginning of the cycle don't know what to think. She is wondering if hers will be right because we have same doc. Oh well.... have a good weekend all!

Ok, two things... I talked to Cynthia at Vandy and she was wonderful!!! She said that she thinks that Dawn is sending the minimum that is required instead of everything... well I did not use names and she isn't pointing fingers but we discussed how she sent only the six months instead of all my monitored diet which Cynthia said would only reinforce my case and that they review and approve everything that they send in order to be sure before they submit it that they are sending everything. I called Dawn again and again she said they won't clarify to her what is wrong and said well it is your insurance company.... I call them they say call her so I am thinking it may be time to cut this off. She apparently is irritated with me and I am irratated with her cause she is not helping. She is just like we will just have to wait but how long am I supposed to sit here and wait for an answer? I am calling Cigna one more time and then I am scheduling to see someone at Vandy... if I don't hear something that sounds like she has my best interest at heart soon I will change. I think her and I have different personalities and just are not meshing. I want to ask ?s and get answers I mean she is the specialist and should know and I find it hard to believe that she can honestly say they won't explain to her what they needed. I mean she has done how many of these? So, I have a game plan. I will call Cigna... then I will see about a seminar at Vandy just in case. I am just disappointed that this is going so negatively.

Melissa, If you feel that strongly about it, then maybe you should go ahead and change now. I say that because you really have to build a good relationship with thestaff of your surgeon because you will be seeing them alot before and especially after surgery. If you are not happy, I would change. I don't blame you. Plus, I love Vandy so of course I am prejudice about swaying you that way! . Vandy has the seminars often. I looked and they have one this upcoming Tuesday. Weather or not you have made up your mind about switching, you should go to that seminar so if you do decide to switch, then at least you can have that out of the way. Also, ask Vandy what steps you have to go through if you do have your filed transferred to them. They may allow you to cut out some steps since you have already been through all of it. You might be able to get it taken care of quickly. I am sure they will have to resubmit to insurance but maybe they will submit everything. And if you do switch and they do resubmit everything, write your own personal letter to the insurance company. I really think it helps. Good luc****ep working at it and try not to let it stress you out. I know you are still recovering from your recent medical problem so try to stay calm and just know that what is meant to be, will be. Misty

I am so sorry you are having all of this trouble with Dawn. I wish I had some answers for you. Dawn was not the person doing the insurance submissions when I had my surgery so my dealings with her have not been in that area. I know that when I called my insurance company, BCBS of MN, they did give me a list of what they would require. Armed with this information, I was able to pull together quite a bit of the documentation before I ever met with Dr. Spaw. Good luck with whatevery you choose to do. Make sure you keep us informed of your progress. Susan

Do you have a case manager with Cigna? (I think that is what they are called ) I haven't had surgery yet, so I can't help much with that.... but with my job, I have had to help families dealing with insurance claims for children with disabilities. Sometimes the case manager can really help--just a thought! Rhonda

Melissa I had problems also... I requested her to send in my records for 5 weeks, as advised by BC, and she didn't do it... I kept asking and no response. I didn't have good thoughts, feelings or dealings.. finally, I was so glad when someone at work trying to go through the same process also had problems... not that i was glad they had problems too... just that it "wasn't just me"... and others were experiencing them too... I didn't take it too personal then... just figured it was time to move on... I had originally chosen Dr. Spaw who was Susan's surgeon... but this one obstacle was such a frustratoin, that I finally just said, OK I've got to do something... probably, if this hadn't been such a problem, I would have chosen Spaw. He is a good Dr. Good luck.... find someone who is willing to help you... who wants your business enough to fight for you or at least give you enough data that you can fight for yourself....

Melissa, I am biased as I used Centennial and couldn't be happier with them. They have always been wonderful to me. Tonya was my financial counselor and she worked with me to help me get all my ducks in a row and then submitted the very same day I turned in my last piece of paperwork and called me the next morning with my approval. That is the kind of service I always receive from everyone at Centennial. Wherever you choose to go, be sure to demand service and don't let them treat you like just a number! You are worth so much more than that. Good luck with everything and please keep us posted!