Micah
Sioux Falls,#2UPDATE Employee
Mon, August 25, 2008
Hi. I work for cigna. I actually work at cigna's mail order pharmacy so I deal with pharmacy claims, but I have seen this issue with their prescription claims. Expensive injectable medications are usually processed through the patient's medical side of insurance instead of pharmacy side. Working at cigna's mail order pharmacy, I have seen claims where cigna medical had approved & told us that the medication WAS covered. So we fill the prescription & mail the medication to the patient. Later, anywhere from a month to a year, cigna reverses the claim & denies it, therefore we no longer have payment for the medication that had already been filled. So then we (the mail order pharmacy) charge the patient the full price of the medication - which can be thousands of dollars! It's kind of the same thing they are doing with your LTD claim. I don't agree with this & feel we shouldn't force the patient to pay the entire cost of the medication - if cigna originally approved the claim then they need to stand by that. If the claim was approved by mistake, then cigna should be the one to pay for THEIR error. And the same concept should be applied to your LTD claim. I am but a "peon" in the company so not much I can do to change this unfortunately. I also have an uncle who is a lawyer & has had many cases AGAINST insurance companies. He explained that once the insurance company has paid a certain amount of money toward something (such as disability claim, cancer treatment, etc) then they do a full & thurough check into the claim to find something, ANYTHING, that would allow them to either stop covering & paying the claim or to deny the claim altogether & try to get back the money they've already spent. My uncle said this is a common procedure with insurance companies & he's had many cases against different insurance companies for these issues. Insurance companies of course have many lawyers working for them & they really fight these cases so it's a long battle! It's unfortunate that insurance companies think they can "toy" with people's health & the money that their customers are due to have! This information may not help your situation much, but I thought I'ld give it to you & congratulate you for standing up to these monsters & wish you great luck with the outcome of your case!