I Just Gave My Firstborn to an Insurance Company

disability

This week Cigna, a large insurance company, was sanctioned by the U.S. Centers for Medicare and Medicaid Services (CMS) for denying health care coverage and prescription drugs to people who should have received them(1). CMS accused Cigna of “widespread and systemic failures,” and said their actions, “create a serious threat to enrollee health and safety.(1)”

Medicare Advantage plans are just a small portion of Cigna’s massive portfolio of insurance plans and offerings, but this type of sanction brings into question the systemic operations and ethics under which the company at large functions.

For example, in a 2010 analysis of data reported to the California Department of Managed Care, the California Nurses Association found that Cigna’s claim denial rate was 39.6% compared to competitors such as Aetna at 5.9% in the same time frame (2). In almost 40% of claims for health care and prescriptions, Cigna denied coverage.

I can’t help but wonder who died waiting for medical treatment that the health insurance company didn’t want to pay for? If they had purchased a plan from a competitor, such as Aetna, would they still be alive?

I spent this past month negotiating a settlement agreement with a large insurance company I fought for two and a half years after falling ill to get the long term disability benefits provided by my employer. I filled out all of the requisite forms, gathered and mailed off all of the medical records. My application was “denied” but with instructions for filing an appeal. So I filled out more forms, gathered more records and received another denial.

More than two years into the process, my family hired an attorney who wrote appeals letters and sought information regarding their review process of this claim. The claim was sent to an “independent, unbiased third party” (who, by the way, was paid for by the company I was fighting) for review who determined that the case was valid and reversed the denial.

One week later, I got a letter from the insurer once again denying coverage due to a “pre-existing condition” that had nothing whatsoever to do with why I was disabled. So after two and a half years of telling me I was not disabled, they were now telling me I was disabled prior to my even applying for disability benefits. The letter also stated that there would be one last appeal after which they would close the case.

It took a second attorney who poured through reams and reams of information, including the company’s own internal communications documents and notes to unearth numerous errors and omissions, including information in my medical records that they at best overlooked, and at worst, choose to ignore.

So I fought harder.

It took two and a half years–after selling my car, moving in with my parents, spending every dime I worked so hard to save, and using all the energy I should have used to fight my illness to fight this insurer – to win the case.

I am pretty certain this company expected me to give up. They wanted me to not appeal for the second, third, and fourth time. They didn’t expect me to hire an independent attorney. And I’m still afraid of them because I feel like they can take more from me.

You see, for profit insurance companies benefit when they delay paying claims. Not only do they continue to receive premiums from policyholders for the insurance plans (generally paid for by employers), but they also receive investment income on the money they continue to withhold even if they eventually plan on paying it out after an appeal.

Back to my settlement agreement. It took yet another year to be granted Social Security disability, at which point I ended up owing the insurance giant tens of thousands of dollars in repayment. Although the money could be paid back in installments over a course of twenty eight years in my case, I also learned that insurers sometimes accept a settlement agreement for a lower amount if paid in cash now.

For a company that counts dollars in the billions, the money owed them was pocket change, if that. To me, it was so much more. Peace of mind. Security. My firstborn.

Due to my autoimmune disease, I’m not sure I will be able to have biological children of my own. As hard as that reality is to face as a thirty year old woman, looking toward a future without children at all is even more difficult. If I were to adopt a child, I would need a reserve of some $30,000-$40,000 at least to make that happen financially (considering I recover enough to be able to take care of a child).

Large insurance companies have entire departments dedicated to collections. They have endless legal access. Patients who have been sick and on disability for years like me can’t afford to hire attorneys to negotiate the settlement. So this time, I went into the arena alone prepared for battle.

To the insurance company, I was negotiating pennies. Me? I was fighting for a future. A firstborn, perhaps.

I’ll let you guess who won.

 

 

  1. http://www.usatoday.com/story/money/2016/01/22/cigna-medicare-sanctions/79160738/
  2. http://www.huffingtonpost.com/wendell-potter/the-higher-health-insurer_b_3137831.html
  3. https://en.wikipedia.org/wiki/Cigna

3 Comments on “I Just Gave My Firstborn to an Insurance Company

  1. Great read, Sarah. I have to continually remind myself that behind all the rhetoric of the healthcare debate in the country there are stories of real people. Not just numbers and dollar bills. Miss you by the way.

  2. I’m so sorry you had to go through all this, Sarah. Our health care system is such a nightmare. I wish you the very best and admire you perseverance.

  3. I am so sorry to here it went this far! As a Rheumatology Care Coordinator, my days are spent with Insurance Companies vs providing patient care/education. This is not what any of us signed up for, thank you for sharing your story.- @RN_Solutions

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