We are currently FIGHTING with CIGNA regarding coverage for a MUCH needed procedure for my wife, who suffers from Venous Insufficiency. The doctor called and advised of the procedural "CODES" they would be using and were informed that they would not pay for the procedure because it included within the description "Varicose".
They said they do not cover "COSMETIC" type of surgeries due to being "ELECTIVE" and not REQUIRED. My wife had a DVT (Deep Vein Thrombosis) prior to this and the need for this surgery is essential for her to maintain good health.
In short the denial could be considered "LIFE THREATENING". But the insurance company arbitrarily denies claims based on a "DATA SET" and not what is really needed to take care of their policy holders. I was on the phone for over an hour just to find out they (CIGNA) would not even discuss this with me, FLAT OUT REFUSED TO TALK TO ME, did not give any directions, processes, or procedures to file an appeal, just "I'm sorry sir this procedure is not covered by your policy" (REPEATEDLY).
When asked to talk to the "Person who could do something" they also refused to allow me to even to talk to "THAT" person.
If you ask me it's "BAD FAITH" all the way. REMEMBER the "DVT"** THIS IS, IN MY WIFE'S CASE POTENTIALLY LIFE THREATENING!!!
Monetary Loss: $10000.