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Comment by woohoo7676 | Hacker News Reader

This has been happening to me for the past several months.

1. Cigna will not tell you for any reason, why the claim is denied

2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial

3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT code for therapy is the same as the equipment code for injections.

So one claim processor decided that the claim was for injections and denied it. Then every subsequent claim has been denied under the same reason.

4. At this point the only option for me is for my provider to appeal every single claim (which takes months), as this is the only way to get someone to actually read the claim and make an intelligent decision.

An absolute nightmare :(

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> 1. Cigna will not tell you for any reason, why the claim is denied

Of course not. Fight fire with fire. Get care providers to sign a letter to Cigna saying the procedure is medically necessary Going through the process will not work and will go slow. But putting them on notice by having licensed, local care providers say something is medically necessary and urgent will work almost 100% of the time.

And blatantly copy your state's insurance regulatory department. Insurers LOVE that.

I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished health…

There needs to be something like the CFPB for health care. I couldn't get an actual human to acknowledge me when dealing with PNC when they ate up my bank, but one CFPB complaint got them to do exactly what I asked. That way you never get to the point of burning time, money, and health because they're afraid of action from the agency.

It would be the state’s insurance regulator, although do not know if they are as effective as CFPB. Financial issues tend to be much less complicated than health issues, and usually just a result of understaffing and underinvesting in customer service.

Great idea - agreed we need an agency to go to that has some teeth, as the insurance co's will never be afraid of individuals.

If you have health insurance from your employer, it's probably covered under ERISA. This is federal, so no help from your state insurance agency and no small claims, and I have found that there are few lawyers who will touch it even in a large city.

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