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Patient Letter - provider has recommended that I have the...

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August 24, 2011 Anita Missengal 705 Austin Avenue Akron, OH 44306 Re: Willy E. Normus       Cigna       Policy #: 123456789 Dear Cigna Insurance Company, Please accept this letter as my appeal to Cigna Health Insurance’s decision to deny coverage for Right Bimalleolar  Fracture (824.4). It is my understanding based on your letter of denial dated September 4, 2010 that this procedure  has been denied because: Lack of funding of Right Bimalleolar Fracture. I have been a member of your Cigna PPO insurance since March 12, 2001. During that time I have participated  within the network of physicians listed by the plan. However, my primary care physician, Dr. Jennifer Snyder  believes that the best care for me at this time would be a Patellafemoral Arthroplasty (27442). At this time there is  not a physician within the network who has extensive knowledge of this procedure. Dr. Kunta Semiodome, a plan 
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Unformatted text preview: provider, has recommended that I have the procedure done outside the network by Dr. Rana del Pastillo at Cleveland Clinic. I have enclosed a letter from Dr. Jennifer Snyder explaining why she recommends a Patellafemoral Arthroplasty (27442). I have also enclosed a letter from Dr. Kunta Semiodome explaining the procedure in detail, his qualifications and experience, and several articles that discuss the procedure. Based on this information, I am asking that you reconsider your previous decision and allow me to go out of network to Dr. Rana del Pastillo for a Patellafemoral Arthroplasty (27442). The procedure is scheduled to begin on December 13, 2011. Should you require additional information, please do not hesitate to contact me at 216-555-1234. I look forward to hearing from you in the near future. Sincerely, Anita Missengal...
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