I have a PPO policy, not a group, no ERISA issues. CIGNA has challenged each submission, uses medical reviewers who are not doctors in the field, violating the law regarding peer to peer review, active practice, same state, within zip of policyholder or doctor.
It violates the laws playing doctor over riding the doctors decisions without having any basis by which they do so. As the policyholder, I am the employer, and CIGNA does not believe they are accountable to me, no explanation or reasons should be provided the person who pays the premium and the salaries of the CIGNA personnel from the CEO down. Everything is medically unnecessary! If that was the case, the doctor should not perform the surgery.
CIGNA does not ask for more background, blanket denial, go appeal our decision. Third-party IME's violate AMA policies to error on the side of the patient, and each submitted bill has had to be processed three to four times to get it done correctly. The State of CA needs to stop the violations and protect the Citizens of CA.
The citizens in CA need to rally against the Attorney General and Insurance Dept for turning a blind eye and allowing CIGNA to get away with abusing the policyholders. STAND UP, SPEAK OUT with numbers, CIGNA will have to change or be fined.
Monetary Loss: $15000.