@Elf1 : I just got off the phone with a nurse consultant from CIGNA, who shockingly called me back. Talk about miscommunication-or no communication in my case-with my claims manager. Here are some of the highlights of our conversation which bordered on ridiculous:
1. The nurse advised me that my claims manager should be calling me at various intervals to discuss the claim. I told her that aside from form letters received in the mail, my claims manager has NEVER contacted me to discuss anything; in fact, the only time I ever spoke with her was when I initiated contact. I told the nurse I'd have a better chance of talking to Elvis or Jimmy Hoffa, and my nickname for my claim manager is "AWOL" because she's never around.
2. The nurse asked me about my "bilateral hip replacement". I told her that although I have bilateral hip replacements, that they were not done at the same time and were done eight weeks apart. The nurse did not realize that my replacements were subsequent, and thought I had both hips done at the same time back in July!. Does anyone read the notes, or for that matter, does anyone take notes? She did state "Well, that changes things".
3. I told the nurse about my being in PT twice a week which I love and is very helpful, that I have PT till 11/26, and that I lost three weeks PT due to Surgery #1 that everyone involved agrees I can make up in December. The nurse DID NOT EVEN REALIZE I WAS IN PT! What did she think I was doing all this time, twiddling my thumbs? They had NO PT notes for me on file and now have to request them. (I called PT immediately after hanging up with CIGNA and tipped them off).
4. The nurse said that they like to contact patients so they can "paint the whole picture" for disability medical reviews. Well, their paint box must have needed refilling because this was the ONLY time any nurse from CIGNA has ever contacted me, and it was only done because the poor customer care representative took my call as a complaint. If "AWOL" did her job, they would have known that my surgeries were consecutive and that I have been in physical therapy for a total of over two months!
So basically I remain unpaid until they get the restriction form from the OS (which he is going over with me on Friday morning) and they get the PT notes to complete another review. And so it goes!