Tuesday, August 16, 2005

Is "JERKS" the Five-Digit Code?

I hate Cigna. I've had nothing but problems with them since Jete's employer changed last year. HATE. HATE. HATE.

I just called to check on the status of Ethan's giraffe stander. His physiatrist prescribed it last month. I had called and spoken to someone in Cigna last month. The way I thought we left it, someone was supposed to be determining which supplier we needed to go through to get it. She said they would get back to me. I haven't heard from anyone since.

Of course, STUPID mother that I am, I didn't write down who I spoke to. Actually, I did, but I think I threw that scrap of paper away.

I'm in the slow learners' class. Sigh.

So, I go through the 75 prompts on the Cigna phone system. I verify my phone number, social security number, birthday and shoe size. Finally, I get to speak to a human being. AMANDA. I wrote her name down in capital letters. I won't be forgetting this time.

I explain the situation to AMANDA. She checks the call history. "Yes, it says here you called on July 7th. But you were only checking what your benefits were."

Silly Amanda. I know my benefits. If there is anything in the world I'm sure of, it's what my insurance plan covers.

I explain that I was told someone was supposed to get back to me, blah blah blah. She sounded puzzled. "That wasn't us. I don't have any record of that." Okay, fine AMANDA. Clearly I had been transferred somewhere else. But - bottom line - I need this stander. She put me on hold for a minute and came back.

"Do you have the procedure code?" The huh? I don't even know what that is, I explained.

She then proceeded to go into a five minute explanation of the five-digit "procedure code" that we need to get from Ethan's doctor. Then they'll review this procedure code, and the predetermination, and the justification. And then, they'll tell me if the equipment is covered or not.

This got my attention. "Yes, but I have full durable medical equipment coverage with this plan. Isn't everything covered?"

"Yes, ma'am. You have full coverage. But we still need to decide if the equipment is medically necessary."

I guess I got a little sarcastic at this point. "Do you get a lot of doctors prescribing equipment that ISN'T medically necessary?"

"Yes. Yes we do." She was silent for a minute. I took a minute to speak. "So what does this mean?"

"We have to get the procedure code, and then we have our own doctors and a team of people who will review the request. Then they'll tell you if we'll cover it or whether you should seek ... alternate ways of handling your ... issue."

Just like his two hour ambulance ride home from the hospital in a full body cast, I suppose. That Cigna decided wasn't "medically necessary" and refused to cover.

Now I was getting red in the face. I could feel it. "Ok. Fine. Just tell me what I need to do. What is my first step to get this stander for my son?"

"You need to call the doctor and get the procedure code."

Fine.

So I've called the doctor, and left a message. Hopefully he'll call back soon, cause it will take ages to get the stupid thing, even if, by some miracle, it's approved.

Which it won't be. I know it. I may be too stupid to write names down. But I'm not that stupid.

2 comments:

sete said...

Okay, I'm ANGRY! I would like to have a word with those people. They will find it medically necessary dammit!!! Let me know if you need me to make a call......because I won't let these people punish Ethan because of their stupid rules and procedures!!!! Ugh!!!!!

Anonymous said...

I couldn't agree more that CIGNA is the worst. They don't have to worry about customer service because it's not like you have another choice to call someone else. I tried to find a sports medicine doc and a dermatologist on their "locate a physician" online. Number listed for the sports medicine doc. was an ear nose & throat doctor. I called CIGNA to tell them and the number they gave me was a fax number. The other doctor they couldn't find. Then, they said their system was saying our call was disconnected, so she would have to hang up and call me right back. That was over 30 minutes ago. Still no way to find Drs. in their network that my kid needs.