Our nearly year-long fight with Cigna has come to an end. We received the decision of the final appeal in the mail today. Cigna’s decisions to deny coverage are overturned! Team Eli is overjoyed. This means we will be reimbursed for his 2015-16 speech, and that going forward, insurance will be covering his speech.
In sum, the reviewer stated: “According to the plan information provided, individual speech therapy is a covered benefit for this patient…Cigna covers as medically necessary ‘a prescribed course of speech therapy by an appropriate healthcare provider for the treatment of a severe impairment of speech/language and an evaluation has been completed by a certified speech-language pathologist…’ Per documentation provided, and as outlined clearly in the appeal letter written by the patient’s mother, he also meets all of the additional required criteria for coverage….The health plan’s determination is overturned in whole.”
Thanks for the shout out, Reviewer Number P064, MD, MPH!
I am honestly still in shock and could not have asked for a better outcome…unless of course they had covered this as medically necessary from day 1, saving time, energy, paper, postage, financial resources and grief. Eli has a long road ahead of him, and this decision reaffirms what we have known all along. I hope that this gives hope to and sets a precedent for others fighting this fight. To the others fighting for their kids, I can only say: Don’t give up the fight. I doggedly pursued this to its end, and it was worth it.
Another apraxia parent told me to get very comfortable with the word “advocate.” I think this is a good start.