My husband was diagnosed with heart disease last December, and until recently, as far as we know Cigna was paying all of the claims, UNTIL my husband reached his out of pocket limit for this year. My husband's cardiologist, who is an approved in network doctor, said that my husband needed to have an ICD implanted, both to help pace his heart due to his A-Fib, and to save his friggen life should he go into sudden cardiac arrest.
The government, due to Medicare being ripped off by too many of these being implanted that didn't need to be, requires that the patient endure a 90 day waiting period, and use medication to see if that alone will take care of the problem, so his doctor prescribed that he use what is called a Zoll Life Vest for that 90 days, which is an external defibrillator, which does the same in case of cardiac arrest. Since this is a life or death situation, we never hesitated to say yes, and we were told by both the doctor and Zoll that most ALL insurance companies fully cover the rental of this vest.
My husband had three hospital stays and, had several procedures done, including the implantation of the ICD, so he easily reached his out of pocket expenses for the year, so surprise, surprise, when Zoll billed Cigna, they unilaterally decided that it would only be covered as an out of network service, since the out of pocket limits are much higher for them.
Zoll is the ONLY company in the country that makes this external life vest, that my husband's doctor warned him he could die, if he didn't have for that 90 day period, that the government requires, and as I said it was prescribed by his IN network provider, so just what BS premises does this rip off company use to say that the device is an out of network service? In other words, there are NO such other devices made that could be considered in network, since Zoll is the only company that makes the device, so basically this disgusting insurance company was telling my husband to either pay out of pocket THOUSANDS more, or just take the chance of dying. When he called them to find out what the *** was going on with this, their only answer was basically kiss off sucker, because we have no duty to tell you WHY we consider this life saving device as out of network, we just do. I know full well, that this is their scam to avoid having to pay for all of it, when he has reached his in network yearly out of pocket cap. Reading all of these complaints here, I see just how terrible this company is, as I have never had these problems with my insurance company, and as soon as this year is over I told him to change companies, since he has several others to choose from, from his employer. It appears that this company is more than deserving of a class action suit, and a governmental investigation into their practices.
Monetary Loss: $3800.