newgal,
You've gotten some good advice here. Since this is YOUR therapy, be sure to get what you want no matter how many arms you have to twist and whatever it may cost out-of-pocket, because in the end, it's what you'll be sleeping with every night......not the insurance providers or the DMEs.....YOU.
Best wishes,
Den
So very frustrating....
Thank you all!
First, thank you all for the great advice! It has really helped me figure out my game plan.
so, here it is: After further investigation, I determined that I can (as you all said) go with a different DME- however, my risk is that they will fill my order, send my requested equipment, and then Cigna will then deny the claim (because there is no documentation in the sleep study of my inability to tolerate the CPAP w/ chinstrap). Unfortunately, I am not in a position financially to eat the cost of the equipment, and at this point I don't think we could even swing the difference between out of network (50% coverage) compared to the 90% coverage I would have in network.
I clarified with both Gentiva and Cigna that Gentiva is actually just getting "predetermination of approval" - and that even if I went with a different DME and got my equipment, Cigna would still send it thru their medical review board to determine if the APAP was "medically necessary". As there is nothing in the sleep study report about my difficulties with CPAP with the chinstrap, I don't feel strongly that I would be successful. I did send a letter (it was assertive and business like, thanks all for the reminders to "play nice" ) which outlined why the prescription was written for APAP based on my experience at the sleep study. I then learned that I can "expedite" the process by having my primary care doctor (who wrote the Rx in the first place) contact the medical director of Cigna. So, the good news is I have a good relationship with my primary care doctor, and he should be calling Cigna on Monday (I have to fax him a copy of the letter I sent to Cigna first, I know more about the APAP now than he does).
I do, already, have a copy of my prescription, as that was previously suggested . Unfortunately, I don't feel that I can take the risk of Cigna denying it after I get my equipment, and it would still have to go thru the medical review board (at Cigna). So, I have calmed down, and will let my doctor call the medical director, and will be patient while they complete their "review". My guess/hope is, once the doctor calls, it will be resolved, I'll get my equipment, and all will be good. And then, I will order all of my future masks from CPAP store, and hopefully I won't have machine issues for the next 5 years (fa la la la la, la la la la - angels rising, chorus, all is good in dreamland )
Thanks again for all of the great advice, and for the support!
so, here it is: After further investigation, I determined that I can (as you all said) go with a different DME- however, my risk is that they will fill my order, send my requested equipment, and then Cigna will then deny the claim (because there is no documentation in the sleep study of my inability to tolerate the CPAP w/ chinstrap). Unfortunately, I am not in a position financially to eat the cost of the equipment, and at this point I don't think we could even swing the difference between out of network (50% coverage) compared to the 90% coverage I would have in network.
I clarified with both Gentiva and Cigna that Gentiva is actually just getting "predetermination of approval" - and that even if I went with a different DME and got my equipment, Cigna would still send it thru their medical review board to determine if the APAP was "medically necessary". As there is nothing in the sleep study report about my difficulties with CPAP with the chinstrap, I don't feel strongly that I would be successful. I did send a letter (it was assertive and business like, thanks all for the reminders to "play nice" ) which outlined why the prescription was written for APAP based on my experience at the sleep study. I then learned that I can "expedite" the process by having my primary care doctor (who wrote the Rx in the first place) contact the medical director of Cigna. So, the good news is I have a good relationship with my primary care doctor, and he should be calling Cigna on Monday (I have to fax him a copy of the letter I sent to Cigna first, I know more about the APAP now than he does).
I do, already, have a copy of my prescription, as that was previously suggested . Unfortunately, I don't feel that I can take the risk of Cigna denying it after I get my equipment, and it would still have to go thru the medical review board (at Cigna). So, I have calmed down, and will let my doctor call the medical director, and will be patient while they complete their "review". My guess/hope is, once the doctor calls, it will be resolved, I'll get my equipment, and all will be good. And then, I will order all of my future masks from CPAP store, and hopefully I won't have machine issues for the next 5 years (fa la la la la, la la la la - angels rising, chorus, all is good in dreamland )
Thanks again for all of the great advice, and for the support!
newgal, I'd still strongly suggest you contact billmyinsurance.com and let them have a swing at it. They'll deal with your insurance company, and quite unlike any other, if they can't get you a better deal than through Gentiva they will let you know.
billmyinsurance.com and cpap.com are the commercial sites behind this forum. Friendly, helpful and knowlegeable people quite unlike any other DME will answer your questions and help you to get what is best for you. And, as I mentioned, if they can't they'll let you know.
It can't hurt to contact them!
I have no affiliation with either cpap.com or billmyinsurance.com except for having been a very satisfied customer of cpap.com and a participant on this forum.
billmyinsurance.com and cpap.com are the commercial sites behind this forum. Friendly, helpful and knowlegeable people quite unlike any other DME will answer your questions and help you to get what is best for you. And, as I mentioned, if they can't they'll let you know.
It can't hurt to contact them!
I have no affiliation with either cpap.com or billmyinsurance.com except for having been a very satisfied customer of cpap.com and a participant on this forum.
The CPAPer formerly known as WAFlowers
Ok, I will admit... I went to their site last night after Rested Gal suggested it. I entered all of my info for the copay quote, but where I got scared was the agreement section where it says I agree/ I don't agree (click one) - the agreement part is you are giving them permission to process it, and if insurance doesn't pay, you agree you are responsible for the charges (at least, that's what I got out of it, maybe the sleep deprivation is hurting my ability to grasp ), so I logged out (sounds of chickens in the background). Granted, it was about 11 p.m and I didn't even try ijust clicking the "do not agree" button (back to sleep deprivation part)...
So, at your strong urging, I decided to try again. This time I called the 1-800 number, got an answering machine (I am guessing different timezone?) Are they only open during normal business hours? I left a message requesting return call.
Thanks for the push, I will continue to investigate other options until I get my equipment.
So, at your strong urging, I decided to try again. This time I called the 1-800 number, got an answering machine (I am guessing different timezone?) Are they only open during normal business hours? I left a message requesting return call.
Thanks for the push, I will continue to investigate other options until I get my equipment.