Dawn Smith vs CIGNA

[Sophie♥Hatter]

http://www.itcouldhappentoanyone.com/ Dawn's blog.

Is anyone following the story of Dawn Smith and her battle with CIGNA health care?

Dear MoveOn member, Last week, over 100,000 MoveOn members stood with Dawn Smith to demand that CIGNA cover the treatment for her brain tumor. CIGNA had been denying Dawn's requests for two years, but when she went public, with the help of MoveOn members across the country, CIGNA reversed course. They took the first step toward resolving Dawn's case—agreeing to pay for the test she needs to determine her treatment plan. By reversing their denials, CIGNA made it clear that they didn't think their decision would stand up to public scrutiny. But they didn't offer any explanation for all the previous denials. And they didn't guarantee that they'll approve the next step in Dawn's treatment. And for all we know, they're still doing this same thing to thousands of other people whose stories haven't caught national attention. That's why Dawn is insisting that CIGNA explain the policies that led them to deny her care for so long. And—for herself and all the others who are suffering—she's demanding proof that they're changing those policies so this never happens again. Dawn recorded a short message for MoveOn members. Can you watch the video and then add your voice to a statement of support? http://pol.moveon.org/dawnsmith/?id=...80-SR7bvZx&t=5 Since Dawn went public, we've heard from hundreds of others who have been hurt by CIGNA. The stories range from simply frustrating to absolutely heartbreaking. If you or someone you know has been denied needed coverage by CIGNA, or by another insurance company, please share your story with us at: http://pol.moveon.org/healthcare/sur...80-SR7bvZx&t=6 All of these stories paint a picture of an insurance company that, as one former CIGNA executive pointed out, has every incentive to deny coverage. * In the case of Nataline Sarkisyan, CIGNA denied a liver transplant—reversing themselves only when public pressure became too intense. Unfortunately, their decision came too late for Nataline, who died. * Christopher Hanna told us the story of his wife's battle—she had to spend "hours every week browbeating [CIGNA] over the phone," fighting to get treated for the ovarian cancer that would eventually take her life. * And of the stories we heard, there were a stunning number where CIGNA authorized a procedure but then came up with an excuse—any excuse at all—to not pay. It's clear that Dawn's experience with CIGNA isn't unique—in fact, it isn't even out of the ordinary. And even though CIGNA would love for Dawn to just go away, she isn't backing down. She's demanding answers and proof that CIGNA is changing their policies so that their mistreatment of her and their other customers comes to an end. Will you watch Dawn's video and sign the statement of support? http://pol.moveon.org/dawnsmith/?id=...80-SR7bvZx&t=7 Thanks for all you do. –Justin, Ilyse, Kat, Daniel, Laura, and the rest of the team P.S. If you have a story about CIGNA or another insurance company denying needed care to you or someone you know, please share it with us at: http://pol.moveon.org/healthcare/sur...80-SR7bvZx&t=8 P.P.S. To read more about Dawn's struggle, check out her blog at: http://www.itcouldhappentoanyone.com/

most recent update to move on from Dawn:

Dear MoveOn member, I'm at the end of my rope. What CIGNA is doing to me is—well, it's outrageous. I have a brain tumor. Doctors are ready to help me. But CIGNA has been blocking me from getting testing and treatment for two years, while almost doubling my premiums. Then, this week was the kicker. CIGNA's pharmacy called to say that the co-pay on the medicine that helps control my debilitating head pain is skyrocketing from $10 to $1,115. That's not a typo. They're making me pay one hundred times what I'm paying now, in addition to my $753/month premium. I can't afford that. So when the pain comes, I won't have any defense. I'll spend hours in the fetal position, out of my mind with pain. When my story went public a couple of weeks ago—with the help of over 100,000 MoveOn members—CIGNA said they would pay for a test I'd been asking for at Cleveland Clinic. It was a step in the right direction. But after two years of denials, and with a long course of treatment ahead of me, I knew better than to just take them at their word. So I asked questions. But they wouldn't offer any explanation for why they denied my coverage for so long, or any assurance that they had changed their procedures so I wouldn't face the same unjust denials again. And I began to wonder if they were more interested in just sweeping my story under the rug than actually helping me. When I got this latest news from CIGNA's pharmacy on Tuesday, I kept asking myself, is this a mistake? Or is this happening because I went public with my case? Are other CIGNA customers receiving the same phone calls? I used to give CIGNA the benefit of the doubt, but after years of unexplained denials, I've had enough. So I'm asking for your help again. For myself, and for everyone else who is suffering, I am asking CIGNA for answers. And I think it would help if thousands of people like you were to join me in demanding them. I'm writing them a short letter with a simple question: Why? Can you add your name to my letter? http://pol.moveon.org/dawn/?id=17404...10-c72pOBx&t=1 Here's what I've written to Dr. Jeffrey Kang, CIGNA's Chief Medical Officer: As you probably know, your company has denied me needed care for two years while I suffer from a debilitating but treatable brain tumor. I pay my $753.47 premiums. I follow the proper procedures. But CIGNA refuses to give me the care I need. Instead, you keep increasing my prices. First my premiums rose by hundreds of dollars, and now my prescription costs are going up by more than 10,000%. What makes you think you can treat sick people this way? When will you stop doing this to me and the thousands of people like me who are suffering? And if you solve this latest problem, how do I know you won't do this to me again next week—that you're actually changing your ways and not just trying to make your PR problem disappear? Please answer these questions. I need to know, for the sake of my health and my life. Many others have signed this letter too, to support me and make sure I get answers. Respectfully, Dawn Smith Thanks for all you're doing. I don't know where I'd be without MoveOn members' help. Most sincerely, Dawn

[Viva]

Yeah I heard about this. Cigna raised our premiums when my daughter was diagnosed until we couldn't afford it anymore... the cost of the insurance got to be more than the cost of her treatment. And they weren't paying for the treatment! Cigna is evil, I sincerely believe they price sick people out of insurance as a matter of policy.

[leiawen]

Cigna is a messed-up organization. My parents and their best friend left the hospital they worked at when Cigna bought it out because of their crappy policies intended to save money.

[LittleMsSunshine]

I'd be interested in seeing her policy's summary of benefits.

If the tests/treatment for her specific condition are specifically excluded in her policy, I'm not entirely sure that CIGNA is in the wrong. Sucks, but it's true.

[sapphiremommy]

Originally Posted by LittleMsSunshine I'd be interested in seeing her policy's summary of benefits. If the tests/treatment for her specific condition are specifically excluded in her policy, I'm not entirely sure that CIGNA is in the wrong. Sucks, but it's true.

ditto to this although it would be unusual to specifically exclude those treatments unless it was a bare bones no cancer major illness coverage. which I've never seen but doesn't mean it isn't possible. if the policy does in deed exclude it then she really has no case but considering that it says "no reason given" I can't help but think that isn't the case. typically if it's excluded they ahve no issue typing out that letter saying "sorry, no coverage". they don't just drag it out.

[LittleMsSunshine]

Ok, so I read the blog.....

The biggest problem, from what I can tell, is that she's trying to get them to pay for care from out-of-network providers.

The vast majority of CIGNA plans are HMO's.... which means they require that you use in-network providers.

Also, it says they jacked up her rates.... it's against the law to do this unless they also jack up the rates of every other person in her age/area group.

IDK.... my heart goes out to her.... but it seems that she does not have a very good understanding of how her specific policy works.

[Viva]

Originally Posted by LittleMsSunshine Ok, so I read the blog..... The biggest problem, from what I can tell, is that she's trying to get them to pay for care from out-of-network providers. The vast majority of CIGNA plans are HMO's.... which means they require that you use in-network providers. Also, it says they jacked up her rates.... it's against the law to do this unless they also jack up the rates of every other person in her age/area group. IDK.... my heart goes out to her.... but it seems that she does not have a very good understanding of how her specific policy works.

The point is that no one understands how their policy works until they get sick and their care is denied. My Cigna policy wouldn't let my daughter see any specialist who was out of network but there was no rheumatologist IN the network. They just did not want her seeing a specialist at all and the doctor they WOULD pay for refused to treat her because he was not a specialist in that field. They make it impossible in many ways.

And the big thing I heard they did was raise the co-pays on her medication. From $25 per month to over $1,000 per month. They just took that drug off the formular and quit paying for it after she had been on it for a year.

IMO that is crap. It shouldn't be that hard. If a doctor prescribes you a drug, the insurance company should cover it. If you are sent to a specialist, it should be covered. All those rules are just ways for the insurance company to get out of paying for the things they are supposed to be paying for.

[Sophie♥Hatter]

I agree Hilary she pays for her insurance, she has treatable tumor the insurance should get her the care she needs. I have no interest in understanding the insurance companies POV it is entirely unethical and just a corrupt system IMO.

[Aunt Sponge]

I'm stunned.

That's horrific - what crap!

THIS is why I DO support government-overhaul of the healtcare system. However, unfortunately, I'm afraid that their multi-faceted focus on a wider variety of things is so vast that the essentials will be overlooked or voted down.

[BubblesofBeer]

That's horrible not surprising at all. But still horrible.