Cigna Health Care - They Are Scam Artists
Health Insurance - Complaint
, MISSOURI -- My husband has Cigna Health insurance through work. In January 2013 he was diagnosed with Cardio Myopathy, and was told by his cardiologist that he would need an Internal Cardiac Defibrillator implanted. Due to a lot of Medicare fraud with these devices, the government has a 90 day MANDATORY waiting period before one can be implanted, during which time the doctor monitors to see if medication alone can help the condition. During that waiting period, most of these patients are prescribed by their cardiologist to wear a ZOLL Life Vest, which is an external vest worn that can shock the heart in case of sudden cardiac arrest.
My husband's cardiologist is an In Network provider, as well as the hospital he uses. The ZOLL Life Vest is the ONLY device of it's kind made in the entire world, so there are no other such devices to choose from, and this is a life threatening condition without such a device. This device is also a FDA Class III approved device, so it is no way considered an experimental device, and MOST insurance companies pay for the use of this device as an In Network device, since there are no others made, EXCEPT CIGNA! At no time did Cigna advise either my husband or his cardiologist that they considered this device as an Out of Network device, and until ZOLL themselves sent us a letter alerting us to this, and informing us that they were appealing this decision, we had no clue.
I made a complaint on the Consumer Affairs complaint forum, and lo and behold I get contacted through them the next day from someone at Cigna who said her name was Ann, and that she would like to help us with this matter. To make a long story short, she was a troll for the company whose job is to go through these boards and act like they are so concerned and want to help you. Well I bit, and sent her the information she said she needed, and she sent me back an email stating she got the info and was already at work researching the problem. Three weeks later, after hearing nothing back, we receive the final bill for what we owe to ZOLL, with the Out of Network charges, meaning they turned down Zoll's appeal, and again no one told us. I emailed Ann again, and this time I am told that she has no access to my husbands records, while remember that she told me she was researching our case and had all of the info, and that she had kicked it up to another department, and had heard nothing back, so surprise, she had just put in another request on the day I just happened to get the bill and emailed her asking her what was going on.
My husband had reached his out of pocket cap for the year BEFORE the ZOLL bill went to Cigna, so we believe that this is an arbitrary decision on their part to charge it as an Out of Network claim, so they won't have to foot the bill for the entire claim, since my husband always uses In Network providers and services, and has not reached the cap for his out of pocket expenses this year. I fired back an angry email to this Ann, which probably is not even her real name, and told her that this was a scam by her company, and that she had openly lied to me from day one, in order to stall, hoping that our time for an appeal would be up.
I filed a complaint with the Missouri Dept. of Insurance, as well as our own appeal to the APWU, which is the union for the USPS that my husband works for, because I am done dealing with this unscrupulous company. They are now going to have to explain to the state where they get off claiming this ZOLL Life Vest is an Out of Network claim, when it is the only device of it's kind made in the world, and FDA approved for my husband's condition.