1 out of every 3 prescriptions has to be justified by my doctor before NALC will cover them
Posted by YikYum on 08/12/2009
WASHINGTON, DISTRICT OF COLUMBIA -- 1 out of every 3 prescriptions has to be justified by my doctor before NALC will cover them. And when my doctor wants to try different dosages my prescriptions are rejected unless I use Caremark, a mail order company, I do not have time to send in a prescription and wait 10 days to get it filled. I'm currently spending 3-4 hours every 2 weeks on the phone, Faxing letters, and running to my doctors to pick up letters of justification. NALC fights 1/3 of my doctors plans, causes significant delays in my medication. If you have a choice you should NOT choose NALC (CIGNA) for your insurance!
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PPO being run like an HMO
Posted by Jo.allan on 01/20/2012
CALIFORNIA -- Since CIGNA took over management of NALC, my health care seems more like an HMO. Referrals for an MRI take an inordinate amount of time, my doctor's decision to order an MRI have been questioned, and the site selected by CIGNA is considered sub-par by two of my doctors. The site chosen for the MRI by CIGNA is a site available to people without insurance in California and the care is considered less than ideal by doctors in my area. Instead of choosing a site from the Preferred Provider List, one must now call into CIGNA/Med Solutions, speak with the person handling your case, and then choose from a list that he/she provides. Then, instead of being able to contact the MRI site (or any other site) myself, I must wait on the line while my "handler" calls the chosen site, speaks with the appointment desk, and then allows me to confirm a time and date for the MRI.
Furthermore, I was transferred 3 times within the CIGNA/Medsolutions labryinth before I actually spoke to the "handler" (my term). I received a letter in the mail today confirming that the MRI would be covered, however, the site mentioned in the letter was not the site where the appointment was made. Also, the MRI ordered by CIGNA was for the thoracic area - not the correct area!! I needed a cervico/lumbar MRI. So now the process must begin again and, needless to say, treatment is being delayed because the diagnostics are being delayed. Can't wait for July when I become eligible for Medicare. I was dreading this transition, but now I'm prepared. It can't get much worse.