Well folks, I got the word today from CIGNA.....THEY CUT ME OFF. No more payments as of 12/10. I figured it was a denial because they left two messages with no status, just a callback request. No one would dare to leave bad news on a voice mail.
When I called back the supervisor, she said that since my 12/13 note said my gait was normal, my incision wasn't split open, and I had no pain to speak of, that this was the needed proof to cut off my benefits. However, they took that note completely out of context and used it against me because the note related to my condition after my fall, not my overall condition. I also find it completely ironic that the opinion of a CIGNA registered nurse/employee, who has never seen me and only talked to me on the phone once for 20 minutes supersedes the medical opinion of a physician assistant and an orthopedic surgeon who not only formerly ran an orthopedic clinic in Tennessee, but is currently the director of the Joint Replacement Program for the entire health system I use, which encompasses three hospitals and three orthopedic offices. And both the OS and PA have seen me and examined me multiple times. So my going to the OS on 12/13 after my ice fall and having the PA see me and document the visit inadvertently threw me under the bus.
I challenged her to set me up for an independent medical examination which I would be more than happy to attend and reminded them how it would not be cost-effective and would basically make them look foolish, but she did not take the bait. And it just hit me....since they believe that my 12/13 visit clears me from disability, shouldn't they owe me payments until at least 12/13?
I do have the right to appeal the decision so since I have nothing to lose at this point, I might as well do so. They agreed to look at my upcoming 12/31 office visit notes and 12/26 PT re-evaluation. And upon my return to work, I plan on notifying our VP of Human Resources about this. Since my company demands the highest customer service standards from its employees, shouldn't it demand the highest standards from the providers it contracts with? I think the VP-who used to be our branch claims manager-would be especially interested in knowing that I had to do the representative's job for most of the claim.
Oh well, it could be much worse....they could have cut me off on 11/5 which is what they wanted to do in the first place. But I am NOT going to let this ruin my Christmas. I will get through this and in 2.5 weeks I will be back at work and earning my paycheck. Meanwhile, I will continue to make the most of whatever recovery time is left, paid or unpaid!