CIGNA Is Still Up To Their Old Tricks. They're Denying Coverage Needed To Treat Cancer Side Effects. UPDATED with video
By Susie Madrak Saturday Oct 03, 2009 12:30pm
Amy Goodman interviews Stacie Ritter, whose twin daughters are being denied coverage by CIGNA for the followup care they need from the side-effects of cancer treatment:
STACIE RITTER: Hi. Thank you, Amy. Thanks for having me.
AMY GOODMAN: Hi, Stacie. Tell us your story.
STACIE RITTER: Well, it’s a rather long one, so I’ll try to make it as brief as I can.
Our issues with insurance companies have been going on now for quite a while. It didn’t start with CIGNA, though, until April Fool’s Day of 2008. That’s when my husband’s employer switched insurers to CIGNA, which, again, as far as healthcare is concerned, you don’t have a choice. When your employer switches insurers, you get what they give you. And unfortunately, we were given CIGNA.
My girls are cancer survivors. They had pituitary and hypothalamus gland damage as a result of chemo and total body radiation to treat their cancer as part of the stem cell transplant that they had when they were four years old. And a lot of times when a child has that issue, they end up on growth hormone. Many years later, once the oncologist notices a—like a plateau in their growth, which mine did back in 2005, so she referred us to an endocrinologist at Children’s Hospital in Philadelphia, and he monitored them. And they didn’t start growth hormone until 2007. So that was two years of monitoring to make sure, you know, that it wasn’t just a little lax in their growth and that it was really a damaged pituitary and hypothalamus.
And once they started the growth hormone under our previous insurer, which was Aetna, they did very, very well. And so, our doctors said, well, then, that’s—their positive response to the medication is proof that it was damaged, then, the hypothalamus and the pituitary gland. So that was great, so we’ll continue to do this until their bones start to fuse and they no longer need growth hormone.
But unfortunately, CIGNA does not feel the same way that our previous insurer and our world-renowned expert doctor felt. So they claim to have had two endocrinologists look at our case, and both of their endocrinologists deemed that my girls just suffer from idiopathic short stature, which means short stature of unknown origin. But quite to the contrary, we know the origin. We have lots of documentation and proof of the origin.
AMY GOODMAN: And that was—you say that was the radiation that they were exposed to to deal with their rare cancer.
STACIE RITTER: Yes. And chemotherapies, too, are very toxic, and also depends on the child’s age at the time, and even the sex has a lot to do with it. So, the younger the child, especially under five, which mine were—they were four at the time—and the sex—females tend to suffer more damage than males for some reason from the total body radiation. Not all children with cancer have these kind of late-term effects. It’s only children who have had radiation to the brain area, which mine did.
JUAN GONZALEZ: Well, and once CIGNA denied you, how long did the appeals process go on for you to try to get them to reverse the decision? And what was happening in between the time that they denied you? Did they immediately—were your daughters then not able to get the drug?
STACIE RITTER: Well, we were very fortunate to be treated at Children’s Hospital. The doctors there know how the insurance companies work. So when I told them ahead of time that my husband’s employer was switching insurers, they immediately enrolled us in a program sponsored by the drug company that makes the growth hormone that we’re using. And that program is like a bridge program, where they will supply and even have representatives represent me in the appeals process. So, no, we didn’t have to go without it, thankfully, because my doctors were proactive and knew that the insurance company was going to go through this and deny it and give us the runaround.
Once—it was about three months of dealing with CIGNA. My doctors called them and did a peer-to-peer, because they were not approving it. The written information and the medical documents were not enough for CIGNA, so they had a peer-to-peer review scheduled. And CIGNA even went as far as approving the medication for my one daughter on that peer-to-peer review with our endocrinologist and claiming that it had no knowledge of my other daughter existing. They had the knowledge that she existed when they sent me the denials for her.
AMY GOODMAN: They’re identical twins.
STACIE RITTER: Yes, mm-hmm.
AMY GOODMAN: Well, we invited CIGNA to join us on the program, but the company declined our request. The spokesperson, Chris Curran, issued the following statement, quote, “There was no laboratory evidence of growth hormone deficiency. Over a year ago, we had two endocrinologists review this case and based on the laboratory studies, they agreed there is no need for the drug. This is the first time we are hearing about the family’s concerns and disagreement with the decision. We would welcome review of new information as technology and medical evidence is in constant evolution." Your response, Stacie Ritter?
STACIE RITTER: That’s a joke. Actually, I just received—every year we have to re-enroll in this program. And my doctor had to resubmit a request for coverage to CIGNA again this year. And we just received this year’s denial letters from CIGNA on the situation and then had to re-enroll again with the manufacturer. And that’s carrying us through then. So they are very aware of this situation. They have been.
Unfortunately, our primary endocrinologist who was handling our case had passed away himself of pancreatic cancer last year. And in the scurry to try to cover all of his patients, you know, all of the doctors there in the endocrinology department have had to divide them up. So I’ve had at least four different endocrinologists from CHOP working on my case alone, from writing letters to the peer-to-peer, to the correspondence from the manufacturer, to me calling them. They’re very aware of the situation.
Login or Register to post comments.
Get the profit motive out of health care.
And the Repugs claim Grayson is crazy.
They need to look no farther then Beck , Rush , Bill O and the Fox comedy group.. When you want to look at criminals then you have Bush , Cheney , Rumsfeld , Rice and all the other republican personal..
You know when a republican is lying , because their lips are moving..
...this may be a violation of mandated benefit laws.
That I see all the rotten health insurance corporations in the country go down the tubes.
They deserve nothing less.
F 'em all.
This health written bill is anything but a welfare check to the Health Empire,, than you have not really read it..
But in fact the reason the democrats have to cut Medicare services and other health company demands in the health bill , was to make sure the Health insurance empires would rake a very health profit..
By the democrats forcing you buy a policy this will be anywhere from 15 to 20 million new policies for the health empires. Would you call that a reform of a welfare check... The democrats have even cut our benefits to make sure the health empires are satisfied..
Obama and the democrats are doing exactly what they claim McCain was going to do ..... A BAIT AND SWITCH>>>
I am done with the deceit and BS for these democrats.. Unless we have a new candidate in the democrat primary I will not vote for one of the corporate democrats..
Of course I agree completely with your digs at the corrupt democrats, but you seem to have left out republican slime all together.
By the way, it's 'democratic party' not 'democrat party.'
Why do insurance companies openly deny things for which customers have extensive documentation? Do they LIKE looking like idiots and liars?
I mean, I can see their denying coverage and all, since they are greedy, vicious vampires. But denying the facts of what they've said and done, when so many people like Ritter come out in the media and show PROOF, not just of their conditions, but of EVERYTHING THE INSURANCE COMPANIES HAVE SAID AND DONE?
Talk about shootin' yourself in the foot.
Are they making record profits? Yes? Then why should they not do idiotic things like this? If someone want to give you money for no reason at all I'm guessing you'll take it.
They know that for every Ritter there are 3-4 people who will cave before the review process is over, and often as soon as it is started. Some victims are too exhausted by their medical problems, some are not educated or bright enough to follow all the company's complex(by design) paper work, many people do not have supportive family or sophisticated enough advocates to help them fight back, and a lot of people can't afford a lawyer to help them who are the only people these companies will listen to with even a little respect. Remember, they can afford to retain the best law firms in the country to deal with their unhappy customers. They literaly wear all but the brightest and most stubborn people down. For every case they loose, they come out scot free on three or four more. Even when they occasionally lose they are winning big time.
Yes, I worked briefly for an insurance company before finding a more honest career compatible with my value system.
Yes, it's when you're most exhausted and depressed that all the paperwork becomes necessary, and when you have to make decisions and reach out for help when you just want to sink through the bed into blackness...
I'm glad you quit working for the insurance company. Maybe you should write some articles about what you saw there.
Because they know we have to work with them to get good care in this country. It doesn't matter how stupid they looks so long as we are forced to jump through their hoops. That's why bare mininum a Strong public option is needed for there to be any real reform. It would stop this sort of bullshit.
They correctly assume that 90% of the people they turn down will give up and go away.
It is a delay tactic. Even when they know they MAY actually have to pay up, they have the interest in delaying the payments for as long as possible, and hide and lie their way through layers of administrative goo goo. The hope is literally that the patient will go away, through one means or another; no preference. MOST people, really, will not challenge them when they through down the paperwork gauntlet (too cumbersome), even after years of paying monthly premiums without so much as an annual exam. So, those who say that they want to keep the insurance that they have, likely have never really had to take advantage of the more involved 'covered' incidents.
The Nataline Sarkisyan case was reported. This 17 year old young girl died 2 hours before CIGNA finally relented to allow her to have a liver transplant. CIGNA pushed it to the wall. Sadly, time ran out for Nataline.
CIGNA is well known for this. They run a very efficient Death Panel.
http://crooksandliars.com/2007/12/21/nataline...
And Sarah Palin and the Grassley freak and Boehner and all the rest of them say something idiotic about Obama's "Death Panels."
How many people have dies because of insurance companies? HOW MANY, DAMN IT???????
why the insurance companies are in business.If I were a customer in the States(thank the good lord, and Canadian medicare I'm not) I would be in deep trouble. I was diagnosed with celiac disease in april of this year and spent alot of time in my doctors office and the local hospital. Not to mention trips to see my specialist as well. I'm gonna take a shot in the dark and say that if I were in america I'd be on the hook for most of my medical bills. If that were the case I'd be camping out in my insurance office demanding a refund.
I was mad with an insurance company many yeasr ago because they didn't want to pay a claim. I phoned the president of the company and very politely asked for either my premiums to be refunded or the claim paid. I had a cheque in my hands the next business day
in Canada? I can't imagine an insurance company like that here.
I don't have much against capitalism but "for profit" health insurance is so wrong. Especially when it is the only choice. I mean really, what do health insurance companies do? They make health care more expensive. That is the only thing they do. They make more money if the people they cover are denied health care. Why is that allowed??? Let me say that again... Health care insurance companies make much more money if they deny health care to the people they cover. How do you think that the CEOs of these companies make 10s of millions of $$$$$. Hun100s of millions of $$$$$$. They make that much money because they order their workers to deny health coverage to people who have their health insurance. And because people pay MORE than what health care actually costs. And health care companies keep raising the price of health care so the their CEOs can make more hun100s of millions of $$$$$$.
We pay double what the next country pays per person for health care. DOUBLE!!!!!! Twice as much. Two times!
Excellent question, Captain Kangaroo. I wish someone could give us an answer.
Insurance companies denying health care to people is criminal, immoral and outrageous.
My heart goes out to Ms Ritter and others like her.
When profit motive is so huge, of course this nonsense proliferates. Still, it will be a relief when it can't happen anymore.
Having been hospitalized last year for two weeks and having my insurance company pay 14,000 on a 73,000 bill, I can only say that thinking there's a special place in Hell for these people is not much consolation.
Is that I wish the president of cigna came down with his own serious illness, or better still one of his immeadiate familly members.And the coup de grace would be denial for a "pre-exsisting" condition
You're right! Thinking there's a special place in hell for them is not much consolation. I want to see a special place on Earth for them!
http://comics.com/pearls_before_swine/
http://www.youtube.com/watch?v=QRHFIVJtqpc
I am sure there are tens of thousands of stories like this.
The Democrats ought to be publishing 5 or 10 of them EVERY DAY.
But of course Rahm probably promised the insurance companies [as part of the closed door deals] that they wouldn't do that.
why not start camping out at your Senator or Reps office. I think we need some major sit-ins at the Senators and Reps offices. Pull a Michael Moore and make a big splash out of it. They treat us as if we were invisible. As long as we are invisible nothing will change. This womens story should be on TV News-Prime Time! She is not the only one. Her story represents about 30% of the insured claims. These people are criminals and they will get away with until we make unprofitable for them to do so. Where is our rage?
http://www.youtube.com/watch?v=Zw5pmDgWMaU
" Making a difference,
one CEO at a time !! "
We the people have been screwed by the very representative who we elected with a mandate and with a current 65% approval for a public option.
What other options do the people have when they throw the bums out, replaced them with a mandate to a different party, who promises changes to the benefit of the people and nothing happens... or worse... they make it worse!
That is exactly what has happened to us. Our options are vote every incumbent out of office no matter what, take to the streets in protest, or start a revolution!
The money the lobbyist are giving our representatives would be called bribery in any other scenario and it would be illegal. If you give a cop $20 to get out of a ticket you could spend a year in jail. Out representatives are taking millions and it's perfectly legal... THAT IS WRONG!
A related, underappreciated, problem is that there seems to be a conspiracy to restrict access to HGH. And to keep the price very high. Most of the world is able to obtain high quality HGH at a very reasonable price, about $100-300. for a months worth (depending on dose). The main supplier, however, will not ship to the United States (due to hassles from the previous administration). So, in the US, patients, and insurance companies are required to pay very high prices (10 times more +) to get it from the US pharmaceutical company. Another reason the Pharm company gives it to you, is so you won't find out how much they rip people off...
Why is it that the party that calls itself pro-business, pro-capitalist, pro-competition, anti-bureacratic, etc - is so dedicated to the preservation of the world's most inefficient, uncompetitive, least cost-effective health insurance sector?
I remember when I was studying economics in university, back in the early 80s, when Reagan first came to power. The media of the day was filled with stories of economic change - companies in every industry were cutting out layers of redundant managers, buying new computer technology in pursuit of greater efficiency, selling old businesses and assets to shed costs, redeploying capital into new, deregulated businesses. This was called 'Creative Destruction', Reaganomics, 'Morning in America'. It was like a second industrial revolution.
Republicans were happy to take credit for revival of entrepreneurial capitalism, which coincided with the revival of stock prices after the bottom of 1982 and Reagan's deregulation and tax cuts.
Now Republicans are doing the exact opposite with health care. They are fighting to maintain sky-high overhead costs, armies of bureaucrats and gatekeepers, and captive markets served by a small number of insurers in each state. They have set fixed prices for drugs in federal entitlement programs, though competitive bidding would obviously save billions of dollars in taxpayer funds.
It makes no sense (other than if you consider what the insurance companies pay in lobbying fees and campaign contributions) - do these people even understand what 'capitalism' and 'competition' mean? .
our employer, Novant Health, which owns 12 hospitals and has almost 27,000 employees is dropping it's contract with Blue Cross Blue Shield and switching everyone to CIGNA. The employee cost will remain approximately the same but the coverage will DROP significantly.
The capitalist pigs who control the United States think they can do anything they want to you and your family with impunity, and they will keep doing it until you finally wake up, rise up and break your chains.
The ONLY hope for the people of the United States of America--and the world--is socialist or communist REVOLUTION. Freedom will come only when we destroy capitalism forever.
PS.: Obama has turned his back on his campaign promises and now supports Bush's fascist military tribunals for Gitmo prisoners. Don't you get it yet, America? Obama is a nice guy and he means well, but he is under the yoke of the 1% ruling class as we all are. True change CANNOT be achieved without the complete destruction of capitalism.
i feel wretched, screw it i need a good rant.
it isn't the health insurance companies denying these children their life saving treatments. oh no. let's call a spade a spade shall we? it's filthy, amoral, unethical, bags of pus, masquerading as humans that work for these companies that have chosen as their life's work to enable the cigna's noble task to aid and abet the unending visitation of this atrocity upon the injured, elderly, sick, needy, and yes, even the dying, among them...their fellow countrymen.
the kicker is...what goes around, comes around, for they too are covered by cigna.i wonder if they'll be so programmed that when the time comes they'll be good l'i'l troopers and deny each other's coverage claims "for the team".
think they'd see the irony? will the last one living remember to turn off the lights when she leaves i wonder?
i intimately understand cigna's actuarial death grip on this family.you see i suffer from a debilitating neurological disorder. incurable. always getting worse by degrees. unless a cure is discovered i'll *never* get better. i was forced to retire on long term medical disability insurance which cigna pays. yet like clockwork, cigna in their infinite wisdom, 4 times a year, forces my dr. and i to fill out forms yet again reiterating that which they already know, that yes indeed, i am still a crip thank you very much mr. bush, and no i haven't gotten any better i've gotten tons worse you festering anal pore due to you delaying research and declaring war on "heathen science" for 8 years while i've slowly watched my body turn into the useless rutabaga that must resemble in function you and your demented republican ilk's diseased corrupted souls and 7 neuron brains. oh by the way cigna, i'm still not falling for that trap you laid for me on that form. you know the one. the one that asks "would you be interested in a rehabilitation program focused to help you be somewhat employable again?" c'mere cigna, l'emme tell ya something. i'm hideously bored not working. i die a little bit each day from terminal ennui. i'd kill to work. but i'm far too ill. i'm not stupid though. i know damn well if i check that box, you'll put me through an ersatz dog and pony show program run by human resources reps that will pronounce me employable, which i'm not, no one will hire me, then when i try to reclaim my full benefits again you'll deny me because your stooges certified me "employable" like the good little corporate pus-bags you trained them to be. then i'll be homeless and eating catfood.
well here's a news flash, screw you and that box you rode in on cigna. i ain't checkin' it.
oh, and by the way, i wrote a check for rep. grayson today too...right off the top of my disability check. now *that's* ironic, don't you think cigna?
bite me.
oh dear, do i sound a mite bitter?
No Public OPTION, No MONEY, NO VOTE
I have a chronic illness. If I was living in the USA I'd be homeless and crippled up instead of living a normal life on universal health care. I can see the US in the future debilitated by corporate greed and right wing ignorance. Their force is powerful I just can't see anyone stopping the runaway train. One more repub presidency should just about do you in. Obama's vision must be realised now, but it will take a powerful change of cultural mindset and unfortunately, puritanical fundamentalism runs too deep in the collective reptilian brain. It will take a revolution to make change.
Many companies provide all funds for their employees healthcare for this service they get favorable treatment on income taxes and Contract to a Private insurance company to handle claims and paperwork. Many times they change insurance companies because another company provides a lower bid for their services.
Dig deep enough and you may discover what insurance companies do is follow the directions of the businesses they represent.
Denying previous conditions may be a ploy for your employer to save money although they have been paying for those Services all along.
We have fought Cigna continually for almost three years. We win but it is not easy. They do lie.
Login or Register to post comments.