Skip to main content

See also:

Cigna's in Denial: Part 2

After three documented instances of authorization Cigna canceled a cancer treatmennt
knowsource.com

There I sat, bursting at the emotional seams, holding in 24 oz of water, trying to reach anybody of importance at Cigna, hoping to go back and finish the cat scan.

During lunch time, the day before Thanksgiving, it was like calling the IRS or EDD, only worse.

After countless minutes of elevator music and feel good Cigna commercials, after betting which will go first, my cell phone battery or my bladder, the person I finally reached informed me that neither the medical director or supervisor will be available until Monday.

To complicate matters, I learned that all my contact history was gone.

All that was present was a record of treatment denial.

Any and all conversations about coverage or authorization had been scrubbed.

All tracks of accountability appeared to be covered.

After receiving a promise that a Cigna supervisor will call me within 24 hours, I told the people at LLU's proton center that my wife and I were heading home.We wanted to avoid rush hour traffic. Nobody of importance could be reached. Nothing would be solved today.

Loma Linda promised to keep my pod for 30 days in case my insurance situation was resolved. That was the only assurance I got to take with me.

"We have a copy of the written authorization", I thought to myself. "There must be some mistake," I told my wife. "We'll straighten things out before the weekend."

Needless to say, Cigna was not on prayer list for Thanksgiving.

On Friday it made my XXX list.

That morning my case worker called to inform me that both Cigna and it's review arm, Care Core, had made a mistake. They should have never authorized my treatment, she explained. I could request a peer to peer review between my oncologist and their medical director to try to overturn the denial. If that didn't work, I could request a expedited medical appeal.

A few days later, the same case worker that was supposed to have helped me navigate the "ins" and "outs" of coverage and treatment over the past several weeks, the same case worker that sent me a written authorization for proton beam radiation therapy, the same case worker that shared my concern and supported my decision, tried to tell me that proton radiation was never an option in my case!

If that was the case, why wasn't I told that in the first place?

If that was the case why was I assured of coverage time after time over the ensuing weeks?

If that was the case why was I, my oncologist and his staff given written and verbal clearance for the treatment.

It all sounded fishy, like a case of the right hand not knowing what the left was doing.

Maybe Cigna had expedited its predicted coverage review and decided to stop before December. .

The case worker's "I'm sorry honey" stung my ears like needles.

I wasn't her little boy.

I was a 64 year old customer that had been promised life changing treatment, who changed his life to make it happen, only to find that the promise was empty.

Over the next two months I realized that Cigna had no intention of fulfilling it.

It didn't matter what my oncologist said to the Cigna medical director in the peer to peer review. (Chauvinistic as it sounds I would have preferred if the Cigna medical director was male. No plumbing empathy there.)

It didn't matter what research the Loma Linda appeals team presented for the medical appeal.

It didn't matter that the HR director of Choc Childrens got involved. (Even though her Cigna rep testified that I had done everything asked of me to qualify.)

It didn't matter that Cigna gave verbal and written confirmation of coverage and authorization from a variety of personnel under its employ.

Legal counsel for the State Board of Managed Care laid out my situation in no uncertain terms.

According to the Knox-Kneen Act, the law that covers the operation of insurance companies in California, Cigna had that right to revoke authorization as long as it compensated me for medical expenses up to that time.

I could sue them for detriment occurred, but I couldn't get them for revoking authorization.

Evidently treatment itself hadn't started. I was still in set-up. They still had the opportunity to revoke,

Even more disconcerting, I learned that the State of California hasn't recognized proton radiation therapy as standard treatment for prostate cancer. (Even though at least 100,000 patients have been successfully treated over the past ten years. Even though there are 13 proton radiation centers across the nation with one targeted for San Diego and another for Los Angeles.)

What's more, I learned Cigna wanted me to settle for less than what I considered my next best options for surgery or radiation.

As lawyers put it, I am faced with a "Hobson's choice" between several "bad" options.

To use an analogy: I wanted robotic, non evasive heart surgery. But Cigna would rather open my chest, crack open my ribs, sew me back up, have me risk clots and stroke, bed ride me and put me through rehab, all because that option was cheaper.

With Cigna it's all about outcomes, not side effects, or quality of life.

It was in the business of health care for profit and it wanted to make that abundantly clear.

On December 2, I wrote Cigna's CEO a letter, appealing to his business ethics, asking him to be accountable for his employees and requesting that he make good on documented promises. (I was told by legal counsel that 90% of lawyers couldn't have crafted a better letter.)

It's February 6 and I still haven't received a reply. I sent the letter registered mail so I know it got to him. Maybe Cordani's mad his salary got reduced to 3.9 million this year. Interestingly enough every single Cigna appeal denial got to me lickety-split.0

It's February 6 and I've received no formal apology other than that placating "I'm sorry honey" from my Cigna case worker. (I wasn't surprised when she was replaced. )

It's February 6 and I still feel punched in the gut, kicked in the balls and both morally and ethically violated.

When I went in for my biopsy in September I was suffering from debilitating inflammation and excessive urination that left little room for sleep. Those symptoms still exist. Every day is a test of survival. If everything went as promised I'd be finishing up treatment by now.

Cigna knows they can afford to play a waiting game I can't.

They know they'll come out ahead if I choose the cheaper option out of desperation or choose another insurance company.

They know they can tie me up for years if I sue for detriment.

Bottom line: they hold the cards and they know I don't have what I need to raise and call.

Last time I looked Cigna's tagline read "in the business of caring."

The way I read it : Cigna cares more about business.

What else would you expect from a company in the business of health care for profit.

What else would you expect from a health care company that promises dividends and rewards cost cutting with cash incentives. (Check out the terms of Cordani's compensation.)

What Cigna did to me is inexcusable and unforgivable.

For me to forgive them they will have to meet three conditions: sorrow, restitution and firm purpose of amendment. (Governor Brown will understand. Rumor has it he had a Jesuit education.)

So far I've seen little, if any, attempt from Cigna, to address any of the three.

I'm not holding my breath.

If you want to help me motivate Cigna, click here to sign a petition.

If you want to help change the law that governs health care in California write your State senator or representative. (Tell them Knox-Kneen has to be revised and why.)

If you've come up on the short end of the Cigna stick, or if they've stuck it to you, share your story on the comment thread.

I've Googled "Cigna denials" and "Cigna complaints" on the internet. I've looked at change.org.

I know I'm not the only voice that needs to be heard.

Believe me, if Cigna thinks it's in the business of caring, Cigna's in denial.

Guess Cordani missed his MBA class in business ethics. Or was it religion class?

Loma Linda University Hospital is a Seventh Day Adventist institution. It's world renown proton radiation center has been in operation since 2000

Related article:

Cigna's in Denial