anthompson87
New member
Original Post
As recommended by someone who commented, I called Cigna on Tuesday to confirm I could submit the appeal. They didn’t answer at first and instead insisted on some sort of verbal re-authorization and tried to call my doctor. I said that was fine but asked my question again in the event they couldn’t get ahold of her and they told me I could not. They then said they got in touch with her and they’d have a decision to me in 20 minutes. They never called back.
I called back yesterday and asked what the results were. Apparently, they only had the receptionist on the line and left a message for my doctor and never heard back. They called her back and left an urgent message with the receptionist. I asked again if I could submit the appeal if she doesn’t call back and this time, I was told I can.
When I get home, I find this letter. I’ve gone through appeals before and have never received anything by like that. Furthermore, both times I called, the appeals department acted completely unaware that they had received the doctor’s request for appeal on 1/2.
I found the highlighted part and all of the docs to submit for an independent external review the most interesting part. They don’t define the “required timeframe” but according to my state’s requirements, N.J. Admin. Code § 11:25-2.3, bullet point 4:
10 business days from 1/2 was 1/15. Funny how that’s the exact date on the letter that took almost 9 days to be delivered 35 miles away from where it was mailed. And that 1/15 was a federal holiday and USPS wasn’t picking up mail that day.
Am I correct in assuming that we’re now eligible for the independent external review since they didn’t provide a decision to the doctor’s request to appeal within the required 10 business day timeframe?
As recommended by someone who commented, I called Cigna on Tuesday to confirm I could submit the appeal. They didn’t answer at first and instead insisted on some sort of verbal re-authorization and tried to call my doctor. I said that was fine but asked my question again in the event they couldn’t get ahold of her and they told me I could not. They then said they got in touch with her and they’d have a decision to me in 20 minutes. They never called back.
I called back yesterday and asked what the results were. Apparently, they only had the receptionist on the line and left a message for my doctor and never heard back. They called her back and left an urgent message with the receptionist. I asked again if I could submit the appeal if she doesn’t call back and this time, I was told I can.
When I get home, I find this letter. I’ve gone through appeals before and have never received anything by like that. Furthermore, both times I called, the appeals department acted completely unaware that they had received the doctor’s request for appeal on 1/2.
I found the highlighted part and all of the docs to submit for an independent external review the most interesting part. They don’t define the “required timeframe” but according to my state’s requirements, N.J. Admin. Code § 11:25-2.3, bullet point 4:
10 business days from 1/2 was 1/15. Funny how that’s the exact date on the letter that took almost 9 days to be delivered 35 miles away from where it was mailed. And that 1/15 was a federal holiday and USPS wasn’t picking up mail that day.
Am I correct in assuming that we’re now eligible for the independent external review since they didn’t provide a decision to the doctor’s request to appeal within the required 10 business day timeframe?