Complaint Review: Cigna Healthcare - Phoenix Arizona

A short time ago my wife and I watched a story on Good Morning America about Cigna denying benefit claims for those on short-term and long-term disability. As I watched this story, I was humbled by the number of people who are gravely ill and, yet Cigna still feels that profit over decency is acceptable. I am also humbled by the fact that I, too, have been denied by Cigna.

My condition, though not as well known as cancer or heart disease, is directly life threatening the silent killer sleep apnea, which if left untreated, can lead to heat attacks, major organ failure, sleep deprivation and strokes. Yet, the fact that its seriousness is lesser known does not make my case any less compelling. I have a family that I need to help support, and I want to spend a full life with them. Also, I paid for these benefits, and I deserve them.

A little more then five years ago, I began having several symptoms, which included choking in my sleep, complete exhaustion, weight gain, tachycardia, night sweats, migraine headaches, and eventually anxiety attacks. I went to several different specialists who offered few answers and little relief. The anxiety attacks, which mostly happened after I went to sleep, began occurring at work. Consequently, I went to see psychiatrist; who within five minutes, diagnosed me with sleep apnea. A pulmonary specialist confirmed the diagnosis.

The extreme form of sleep apnea I have has not responded to standard treatment, including the new stimulant medications. My tachycardia prevents me from taking these stimulants. Also, my body frame does not make me a good candidate for the different surgeries that have helped others. The doctors told me that I have most likely had sleep apnea most of my life.

As a result, I have developed cognitive impairments, short-term memory loss, diabetes, daytime sleepiness and fatigue, sleep deprivation, insomnia, a short attention span, and difficulty following instructions and remembering even the simplest tasks. Some of these symptoms occurred before my treatment this lead to difficulty at work. My background is in industrial and process engineering. I worked for one of the major aeronautical and military firms. My job was very demanding and highly stressful. Each week was a minimum of 60 hours.

At first, it felt like I was always exhausted and I was always getting sick. Then the weight gain started. Both I chalked up to a stressful work load and that I have always struggled with my weight. When the massive migraines in the morning began, I started missing work. Human Resources stepped in and I was written up for missing too much work. Not knowing what was wrong with me, I accepted the reprimand.

After my first sleep study, and subsequent diagnosis, I had four more sleep studies within an eight-month period. My doctor told me that this was the worse case of sleep apnea he had ever seen. One of the test revealed that I was able to fall asleep within five minutes, even after a full nights rest and at 9 a.m. Therefore, I was told that I was not to drive. I took a short-term medical leave based on my doctors orders to recover and to let the treatment plan have a chance to work.

My company was not happy with me taking the short-term medical leave, and made that time miserable. During that time, I was required to call the medical department daily to let them know that I was still going to be out. The company nurse told me that my job was on the line. Also, if the company doctor felt that my test results were taking too long, he ordered me to sit in my treating doctors office until I was given the results. Of course, I did no such thing. (Note: This happened during the 2004 hurricane season, when Orlando, Florida, was hit three times.)

Subsequently, I hired an attorney to protect my job. After I returned from short term medical leave, I found my job was no longer available and I was placed in a job that I had not had any formal training. I struggled to keep up. However, when it became apparent that I could no longer do my job, I went on long-term medical leave at the recommendation of my treating doctor.

Since, I had already had an attorney, Cigna approved the first year of my leave. Still, every month, I had some hurdle they made me leap through. After the first year, Cigna required more and more paperwork and doctors visits, along with a functional capacity test. According to both my treating doctor and my attorney, the company that Cigna used was not qualified to perform that test.

Over the next year, I had additional a sleep study, and updated settings on my breathing machine until it was at almost the highest level prescribed. When I still was not getting any better and my treating doctor had done everything he could, I began seeking out other specialists to look into my case. A neuropsychologist confirmed my cognitive function impairment.

This was important because Cigna was claiming that my main disabling symptom was psychological, and consequently trying to drop my coverage. However, numerous tests clearly showed that my condition stemmed from a physical and not a psychological origin. I also saw a neurologist, an endocrinologist, two cardiologists, and continued check ins with my pulmonary specialist.

After exactly two years, September 2007, Cigna dropped me, stating that I was fully capable of performing my previous job, or at least a job that could earn as much as the benefit was paying; despite numerous doctors sworn statements to the contrary. I continued to see my doctors and to work with my attorney to try to get my benefits back from Cigna.

In February 2008, my pulmonary specialist referred me to a research medical institute, with the hope that they may have a better chance to determine what my conditions root cause was and a treatment plan. In March 2008, I started being treated by the Mayo Clinic, staffed by some of the most respected medical professionals in the country. The doctors there agreed with my other doctors that at this time, I am incapable of working as a direct result of severe sleep apnea. They have provided both Cigna and my attorney with documentation to this effect.

Over the past nine months, Cigna has slowed walked all the paperwork I and my attorney provided. Recently, they claimed that my attorney was not authorized to speak on my behalf, which is another slow-walking technique. After signing the new authorization, my attorney received copies of all Cignas documentation for their reason for my termination. On top of the stack was the original authorization for my attorney, but nothing that would indicate cause for termination.

Since then, Cigna has continued to drag out every interaction we have. On June 1, 2008, just before they used up all their extensions, they sent my attorney a letter stating that they were using a third party company to review my case and that they would need another 30 days. After those 30 days were up, they denied my claim, but again without reason. My attorney has requested it, but we have yet to receive it.

The consequences of Cignas actions to me and my family have been devastating. We have had difficulty taking care of our basic necessities. Weve had two cars repossessed as we tried to keep up with the medical costs, and our home has been in jeopardy more than once. All we wanted was for Cigna to provide the benefits it is legally and honor-bound to provide, and so far, we have seen the opposite.

The worst part is, this company has been hit with the occasional individual civil suit, but no state or national consequences seem to be severe enough to prevent them from doing what theyre doing forcing thousands of people to struggle for the benefits to which they are entitled, at possibly the weakest point in their lives. Cant we change this?

My family and I would greatly appreciate any help you could provide in this matter.

Lee

Apopka, Florida

U.S.A.