I have been going through appeals for two medication’s for the last 30 days. After their denial, we submitted a appeal, and I received a letter stating that we would have a decision within 30 days when I called for an update they stated that due to my policy, they were not have a decision until 90 days and since there’s a lot of appeals it may be longer. I have been on this insurance for over a year and have never heard this before as they have always followed the 30 days outlined in the denial letters. I’ve now spoken with six different representatives, and two supervisors who are telling me the same thing (90 days) even though my benefits provider and federal ESIRA representative stated it should be 30 days as noted in my letter from Cigna. Are they legally allowed to delay my medically necessary care for 90+ days when both my policy and their official denial letter state that they have a maximum of 30 days to respond. What action can I take regarding this as both medication’s that are being appealed are necessary and time sensitive.
One is a CGM for severe hypoglycemia and the other is Botox for chronic migraine (I developed resistance/antibodies to CGRP inhibitors, and I failed other treatment, currently having 23 migraine days a month). My doctors are canceling the appeals and re-submitting the prior authorizations but I’m still wondering how do I fix the appeal process going forward so that my appeals are handled in a timely manner as I am on high cost Biologics & Blood products for my autoimmune diseases that if they deny and require an appeal could be life-threatening to wait 90+ days.
*COBRA Policy that I stayed on from my ex husbands prior employer. I’ve spoken with the benifits director and they are not getting an answer from Cigna either
submitted by /u/Adventuous_Equal_547