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HenryLacroix

Coverage Denied For Inpatient - Any Advice?

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Hi everyone,

 

Cigna denied coverage for my inpatient stay for alcoholism in April 2014 (I did not have coverage when I went in and paid cash, but signed up for COBRA, which retroactively covers anything up to 2 months prior to signing up). The reason for the denial was lack of medical necessity, no history of relapse, and I had not failed outpatient before trying inpatient.  

 

Here is what I am doing:

-Providing documents showing medical necessity from the inpatient facility

-Providing documents showing I went to the ER several times for withdrawals

-Filing a complaint with the state insurance commissioner 

-Including a letter detailing my history with alcohol and its negative effect on my life

 

If anyone has any suggestions beyond what I have listed above, I would greatly appreciate them!

 

Thanks!

Henry

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If you had been seen by your gp about your alcohol problems. Prior to your admission to the Reba facility, Cigna would have a history of your condition prior to admission. Have your gp help you with your appeal. I had Cigna for many years. I only had a problem once with them. They stopped paying in the middle of treatment for a serious accident I'd had. My job at the time was dealing with all health insurance plans in the US. I was able to get things resolved without going to hr. Check your Explanation of Beneficits to be sure alcohol/drug rehab is covered.

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If you had been seen by your gp about your alcohol problems. Prior to your admission to the Reba facility, Cigna would have a history of your condition prior to admission. Have your gp help you with your appeal. I had Cigna for many years. I only had a problem once with them. They stopped paying in the middle of treatment for a serious accident I'd had. My job at the time was dealing with all health insurance plans in the US. I was able to get things resolved without going to hr. Check your Explanation of Beneficits to be sure alcohol/drug rehab is covered.

Excellent, thank you for the response.  I have filed an appeal and included the medical records.  Wish me luck!

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