Cigna - Denial of covered claim
Through my doctors it was discovered that I have sleep apnea.I had to do a home study to confirm this and I had what they call 13 "obstructive" events and 1.2 "central" events.
Obstructive, your breathing is interrupted (back of your throat) and you are trying to catch your breath, that terrible snoring sound. Central is when you quit breathing altogether and everything loses oxygen including your brain. The 13 and 1.2 are per/hour. The central is what is significant here and my total apnea score was a 27.
Anything over 5 scores you with apnea and 30 begins the severe mark. Therefore the doc wants me to go for an in-house titration-study to make sure I get regulated properly for the CPAP mask (fun) due to the central events. I will be paying $800 bucks due to not having met my ded yet. Cigna denies it.
We set up a peer-to-peer call, in short because even getting that done was a fiasco, so that my doc could speak with the CIgna reviewing Physician that denied the claim. They upheld the denial because I do not have any heart conditions, am not morbidly obese, no high BP....basically I am not "unhealthy" enough. I need to be more unhealthy before they can approve the claim! How ridiculous is this?!
I am not the typical person to have sleep apnea but it comes in all shapes and forms. I didn't do enough to make myself get sleep apnea therefore they cannot approve the claim! Never mind that my family history shows my Mom having it and my cousin died from it at the age of 34! Cigna cares about nothing but their bottom line.
Oh, and I'm sure the "Cigna physician" has my best interests in mind!
Never thought I would say this, but I cannot wait for my company to go strictly HSA next year and drop Cigna like the piece of garbage they are.Maybe then I'll have a little more control over what is approved and what isn't.......I'll be broke...but I won't be a slave to the corporate health machine!
Review about: Cigna Medical Claim.
Reason of review: Poor customer service.
I didn't like: Getting the run around with every cust svc number you call.