robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
I was talking to Cigna today and they suggested I might ant to sign up to get a Case Manager. It "free". I am a bit leary of this as I feel if I call attention to my case they may start denying things. I mean it sounds to me like a way to cut costs for them rather than help me. Maybe I am too cynical.
Anyone ever have experience with this type of setup?
robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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We just got switched to Cigna PPO Plus - which I have yet to get all the kinks worked out from the switch.
Right now, my out-of-network doc is handling all the filing - so I am lucky in that regard.
In my opinion, I would avoid the case manager idea because you KNOW their interest is to save money - not really in saving YOU. It's nothing personal - it's just business.
Just read up on it, and maybe ask your doc what s/he thinks.
But Dr. Wiseass says: BEWARE!
-------------------- DR. Wiseass NOT a real doc - just a real wise Posts: 792 | From USA | Registered: Jan 2005
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Mathias
Frequent Contributor (1K+ posts)
Member # 5298
posted
I would avoid the case manager, flying under the radar is always better.
-------------------- Mathias Posts: 1250 | From New Jersey | Registered: Feb 2004
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
Your instincts are correct. Follow them. I used to do that type of work for a living ... except on Workers' Comp and LTD cases. Same thing, though. My job was to determine the appropriate course of medical treatment and help guide that person through it.
With an extremely controversial diagnosis like Lyme, no doubt the case manager will direct you toward the standard treatment in mainstream medical literature. There is an outside chance that you will find someone who is an advocate, who knows Lyme and knows the controversy. But not likely.
Chances are this person would become more of a whistle-blower. We all know that it is more convenient for the insurance company to go by the mainstream medical literature as it is cheaper.
These case managers can be wonderful when it comes to something more clear cut, like cancer, a brain tumor, diabetes, things like that. But with a diagnosis as controversial as Lyme, run the other way.
Of course, you may eventually have no choice in the matter. Some insurance carriers have set $$$ amounts plugged into the system and when a case hits that amount, a case manager is assigned whether the claimant wants one or not.
Isn't Cigna based in Richmond? I used to work for a disability management company called Intracorp which was a spin-off company of Cigna. Intracorp generally provided medical management on many Cigna claims.
Posts: 2276 | From NC | Registered: Oct 2000
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I sent you a private response. Check your private mail, (I have no idea how!)
Wizard
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robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
Thanks for all the expert resposes ........... I didn't think it was a good idea .... nice to I am not just paronoid ........ they really don't like us.
robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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Lishs mom
Frequent Contributor (1K+ posts)
Member # 2344
posted
Robi, We had Cigna....still do I think, but they demanded we get a case manager. I explained that I had been managing my daughter for 9 years just fine, and how could they do anything differently.
She said, well Lyme Disease needs special manangement. I asked who would manage it...she explained that she would.
I asked how decisions would be made, she said by their in network specialist. I asked what credentials that in network specialist, she said he was a pediatrician.
I said no thanks, but thanks anyway.
The following week we got a call, frm our case manager. I said, I didnt think we had a case manager. She said, well we were assigned to you, and your daughters records have been reviewed by our pediatrician and he does not think she has lyme.
I asked if he had reviewed my daughters records by her specialist, and if he had evaluated my daughter personally. She said no to both.
I asked what did he think she had...he said she needs psychology help, she is a manipulative child who is trying to get attention (mind you this is my daughter who just spent a year in congestive heart failure due to lyme disease...and was being treated now for almost 9 months and doing significantly better!)
Make a long story short, they quit covering her expenses, and we payed out of pocket.
I need to give you information on steps to take to protect yourself that we learned after the fact
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