Tim and I took out private health insurance here in Australia. We became eligible for Medicare - Australia's public health insurance - in October. Even with the public health program, many people who can afford it, take out private insurance as well. For one reason, there is a tax rebate for people with private health insurance. I assume the reason is that private healthcare relieves some of the stress on the public system.
There is a general rule here, that if you have had hospital coverage prior to enrolling in a new program, that your benefits will continue if you enroll within two months of terminating your last insurance (hence no 2-month waiting period or pre-existing condition clauses). There is some question whether our expatriate coverage that was provided through CSIRO (until Medicare became effective by becoming permanent residents) is eligible for this 2-month continuation rule. The interesting item here, is that our new health insurer is helping us get that continuation of coverage - i.e., save us money which could potentially cost them money!
Comparing this to our experience with Cigna - well, in fact there is no comparison! I had to fight Cigna for almost every claim I ever made, which usually meant dealing with some very unpleasant (read: rude and abusive) Cigna employees.
I know that the USA doesn't have public health - unfortunately - but why can't US insurance companies be less adversarial? Why can't they pay claims without going through all the games of denial - so that only the most persistent of people get reimbursed?
I am not afraid to talk to people who work for our new health insurance. In fact, the people I have dealt with are absolutely lovely. One woman has been trying different avenues to allow us to get the continuation - going out of her way to help us! I have never had that happen to me in the United States - in dealing with health insurers. I actually dread every time I have to speak with Cigna, because I know it will be stressful, and it usually means more of my time to "justify" to them why they should pay my claim.
I have been reading about Cigna, which includes Cigna forums online. Apparently, the morale at Cigna is at an all-time low. Several employees said they have to perform the jobs of 2 or more people. One person said their insurance benefits were poor. It doesn't seem surprising to me that employees would have low morale - for all the reasons stated and because they are encouraged to hang up their ethics before entering the place of work. How satisfying can it be to constantly say "no" to people - which possibly means going against their own better judgment or nature? The more you deny claims the more you advance in the organization... does this sound right, moral or good?
The Health Insurance industry in the US needs an overhaul. Perhaps they could learn something from Australian insurers?
Wednesday, March 19, 2008
Wednesday, March 12, 2008
CIGNA and Catch 22
There was only one catch and that was Catch-22, which specified that a concern for one's own safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he was sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle.
"That's some catch, that catch-22," he observed.
"It's the best there is," Doc Daneeka agreed.
CIGNA has its own Catch 22. Leaving aside a lot of extraneous, distracting, and basically irrelevant stuff, CIGNA's case against Judi is that it doesn't believe her doctor's statement that Judi is not able to work. The only way to prove that she can't work is to try to. If she tried to work and then got sick, she would have already lost her coverage by CIGNA anyway because she would no longer be eligible because she is working! It's as beautiful (and obscene) as Catch 22.
Tim
"That's some catch, that catch-22," he observed.
"It's the best there is," Doc Daneeka agreed.
CIGNA has its own Catch 22. Leaving aside a lot of extraneous, distracting, and basically irrelevant stuff, CIGNA's case against Judi is that it doesn't believe her doctor's statement that Judi is not able to work. The only way to prove that she can't work is to try to. If she tried to work and then got sick, she would have already lost her coverage by CIGNA anyway because she would no longer be eligible because she is working! It's as beautiful (and obscene) as Catch 22.
Tim
Monday, March 10, 2008
CIGNA and morality
Judi's post says a number of things that need to be said about her specific case. Driving back tonight, I was pondering how to communicate the true awfulness of CIGNA's actions in her case. CIGNA benefits from hiding in plain sight - there are so many cases of this sort that only the most egregious get the deserved attention from the media. I'd like all CIGNA case workers to act as though each case would be on the front page of the New York Times. It's a variant of the old adage that one should act as if the whole world is watching. I think CIGNA's actions in her case fail this test.
We are in the process of appealing (again).
Tim
We are in the process of appealing (again).
Tim
U.S. INSURANCE COMPANIES SHOULD BE ASHAMED
I feel a need to talk about private (or company-sponsored) disability insurance. Disability insurance is something an individual signs up and pays for, with the understanding that if they become disabled, i.e., unable to work, then their insurance provider will pay a percentage of their salary at disability until they are able to work again. Most people depend upon this income, and the income they receive from SSDI (social security) to live.
I went on disability in the summer of 1998. Not working was incredibly difficult for me, because I enjoyed work and I derived self-esteem and a sense of identity from my job. It is obvious to Tim and I that I cannot work - my mental health won't allow for it. In past posts, I have discussed my MPD/DID and some of the symptoms I get. Some of my symptoms I prefer not to talk about here because they are of a more private and sensitive nature. However, some of my symptoms are consistent with most “mentally ill” people, e.g., difficulty concentrating, problems with interpersonal relationships, the inability to deal with various environmental stimulants (noise, talking, music, heat, crowds, etc.). With trauma survivors, there is also the chance of becoming triggered by an event or a person. When triggered, a person could have any type of originally adaptive, but possibly, negative response (e.g., crying, hiding, dissociating (spacing out), anger, hostility, etc.).
Since I was diagnosed in 1997, my life has changed. I had already suffered from depression, so I was used to the excessive sleeping and isolation. At one point, I tried to do too much and ended up in the hospital from a “breakdown” of sorts. What occurred is that one of my child alters attempted suicide by overdosing on prescription medicine (with a wine chaser). This might seem unbelievable to most readers of this blog, but I still have the note written in a child's hand saying “Judi go bye bye”. Even more strangely, I watched this event from somewhere up by my dining room's ceiling. Fortunately, I had helper parts of me who thought to call my psychiatrist, and an ambulance arrived at my door. I hardly remember the stomach pumping at the hospital, but I recall enough to know that I don't want to ever experience it again. As I write this, my mind darts to all the things that need more explanation, but I am not inclined to get into that much detail here.
Returning to the purpose of this entry, disability insurance in the United States is a huge and corrupt scam. I read an excellent article recently:
“Practices in Health care and Disability Insurance: Delay, Diminish, Deny, Blame”
by Peter Phillips and Bridget Thornton
(I can send you a pdf copy by email if you'd like to read this article.)
This article explains how the insurance industry has become so corrupt and why the disabled population - people who have the least energy or ability, but often the greatest need - are put through hell in attempts to get what is rightfully owed to them. Cigna Healthcare terminated my disability insurance benefits effective last summer. Since that time, Tim and I have been appealing their decision, currently working on a new appeal since the last appeal was denied. My doctor has stated that I am unable to work and why. Cigna, however, has chosen to follow the assessment of two doctors who do not know me, and are obviously quite ignorant about DID. Cigna is also basing most of its decision to terminate my insurance on this blog! For example, because they read that I was able to attend and enjoy an opera with Zoe and Tim, that I must be able to have sustained concentration over a period of time. An opera? I'd bet that any number of mental hospitals would love to have opera available to their patients to enjoy and relax with. So a three hour light opera proves that I am able to work - what are they thinking? This is just one small and silly example of their reasoning.... it goes on and on.
I heard that Cigna, among other insurance companies, was mentioned in Michael Moore's film, Sicko. Apparently, the staff who pay claims are awarded for how many claims they deny. The more claims denied, the better the advancement and compensation. I know this has to be true, because as a former HR professional and on behalf of employees, I had to fight Cigna on several occasions to get claims paid that should never have been denied in the first place. Now, since I have been sick, I have had to do the same for my own claims. I still haven't been paid for my last claim submissions, and it has been months. The last Explanation of Benefits I received was ridiculous. They denied most of my doctor visits because my provider's number was not listed (or something like that). Well, duhhhhhhhhhhhhhhhhh, she's here in Australia! Wouldn't you expect the international claims people to figure out that the provider numbers might be different in a country other than the US? I am certain that they just made up ridiculous reasons to deny my claims, hoping that I would get tired of fighting them. Unfortunately, that's what many people do. They give up and give in to the insurance companies - mostly because they are intimidated by insurance or rude and abusive claims people, or they are too sick or tired (or tired of caring for a sick loved one), to keep fighting.
Something has to change. I am tired of fighting, but I also can't give in because I really can't work now and I am entitled to the insurance payments.
I want to work. I like work. I would like the better income that work provides me.
Since Cigna has been monitoring this blog, they will probably say that what I have just written indicates my ability for sustained and coherent thought thereby proving that I am capable of maintaining employment. I never said I was stupid, I just told them that some days I can't go outside, talk to other people, or answer the telephone. Hmmmmm, why would that interfere with a job do you think?
Hopefully more ranting and raving to come....
Judi
I went on disability in the summer of 1998. Not working was incredibly difficult for me, because I enjoyed work and I derived self-esteem and a sense of identity from my job. It is obvious to Tim and I that I cannot work - my mental health won't allow for it. In past posts, I have discussed my MPD/DID and some of the symptoms I get. Some of my symptoms I prefer not to talk about here because they are of a more private and sensitive nature. However, some of my symptoms are consistent with most “mentally ill” people, e.g., difficulty concentrating, problems with interpersonal relationships, the inability to deal with various environmental stimulants (noise, talking, music, heat, crowds, etc.). With trauma survivors, there is also the chance of becoming triggered by an event or a person. When triggered, a person could have any type of originally adaptive, but possibly, negative response (e.g., crying, hiding, dissociating (spacing out), anger, hostility, etc.).
Since I was diagnosed in 1997, my life has changed. I had already suffered from depression, so I was used to the excessive sleeping and isolation. At one point, I tried to do too much and ended up in the hospital from a “breakdown” of sorts. What occurred is that one of my child alters attempted suicide by overdosing on prescription medicine (with a wine chaser). This might seem unbelievable to most readers of this blog, but I still have the note written in a child's hand saying “Judi go bye bye”. Even more strangely, I watched this event from somewhere up by my dining room's ceiling. Fortunately, I had helper parts of me who thought to call my psychiatrist, and an ambulance arrived at my door. I hardly remember the stomach pumping at the hospital, but I recall enough to know that I don't want to ever experience it again. As I write this, my mind darts to all the things that need more explanation, but I am not inclined to get into that much detail here.
Returning to the purpose of this entry, disability insurance in the United States is a huge and corrupt scam. I read an excellent article recently:
“Practices in Health care and Disability Insurance: Delay, Diminish, Deny, Blame”
by Peter Phillips and Bridget Thornton
(I can send you a pdf copy by email if you'd like to read this article.)
This article explains how the insurance industry has become so corrupt and why the disabled population - people who have the least energy or ability, but often the greatest need - are put through hell in attempts to get what is rightfully owed to them. Cigna Healthcare terminated my disability insurance benefits effective last summer. Since that time, Tim and I have been appealing their decision, currently working on a new appeal since the last appeal was denied. My doctor has stated that I am unable to work and why. Cigna, however, has chosen to follow the assessment of two doctors who do not know me, and are obviously quite ignorant about DID. Cigna is also basing most of its decision to terminate my insurance on this blog! For example, because they read that I was able to attend and enjoy an opera with Zoe and Tim, that I must be able to have sustained concentration over a period of time. An opera? I'd bet that any number of mental hospitals would love to have opera available to their patients to enjoy and relax with. So a three hour light opera proves that I am able to work - what are they thinking? This is just one small and silly example of their reasoning.... it goes on and on.
I heard that Cigna, among other insurance companies, was mentioned in Michael Moore's film, Sicko. Apparently, the staff who pay claims are awarded for how many claims they deny. The more claims denied, the better the advancement and compensation. I know this has to be true, because as a former HR professional and on behalf of employees, I had to fight Cigna on several occasions to get claims paid that should never have been denied in the first place. Now, since I have been sick, I have had to do the same for my own claims. I still haven't been paid for my last claim submissions, and it has been months. The last Explanation of Benefits I received was ridiculous. They denied most of my doctor visits because my provider's number was not listed (or something like that). Well, duhhhhhhhhhhhhhhhhh, she's here in Australia! Wouldn't you expect the international claims people to figure out that the provider numbers might be different in a country other than the US? I am certain that they just made up ridiculous reasons to deny my claims, hoping that I would get tired of fighting them. Unfortunately, that's what many people do. They give up and give in to the insurance companies - mostly because they are intimidated by insurance or rude and abusive claims people, or they are too sick or tired (or tired of caring for a sick loved one), to keep fighting.
Something has to change. I am tired of fighting, but I also can't give in because I really can't work now and I am entitled to the insurance payments.
I want to work. I like work. I would like the better income that work provides me.
Since Cigna has been monitoring this blog, they will probably say that what I have just written indicates my ability for sustained and coherent thought thereby proving that I am capable of maintaining employment. I never said I was stupid, I just told them that some days I can't go outside, talk to other people, or answer the telephone. Hmmmmm, why would that interfere with a job do you think?
Hopefully more ranting and raving to come....
Judi
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