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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 07-08-2014, 11:11 AM
Optimistic Optimistic is offline
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Join Date: Mar 2014
Posts: 81
Default Cigna - Class Action Suit?

While I have read of some insurance claims that have been successful, I also read of many that were unsuccessful....after multiple denials & appeals. Harrison posted a file with many successful claims (>300) but this file was strictly for FDA approved Charite discs and the file is over 8 years old (and the Charite is no longer available).

Harrison attempted to update a list this year with successful appeals from all insurance companies. I believe there was a lack of response and he did not produce the list.

I am in the process of appealing a denial I received from Cigna. I will go through the paces but do not have high hopes for success, in spite of a judge ordering Cigna to pay one claimant after a successful individual law suit.

Are there other Cigna members that might be interested in a class action suit against Cigna or potentially multiple insurance carriers? If there are many others that are willing, there may be value in numbers. What do you think?
__________________
1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.

New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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  #2  
Old 07-10-2014, 11:34 PM
Kelly4ADR's Avatar
Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
Posts: 259
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Optimistic,

I sent you a pm with my appeal info about an hour ago, I hope you got it and it was helpful

I think you have a good chance overturning your insurance denial. Given your insurance is Cigna... They were one of the first to approve a two level cervical.

I am insured with Aetna. I would be interested in a possible class action, if all the variables fall into place. PM me if you want to discuss further.
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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  #3  
Old 07-11-2014, 11:21 AM
Optimistic Optimistic is offline
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Join Date: Mar 2014
Posts: 81
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Thanks Kelly, I did receive it. I will be working on an appeal. I am still looking to see if a lawyer and/or advocacy group will either support me or undertake the preparation of the case. As you know, there is a lot of work in preparing the appeal. Like others, I will probably ask members to review my documentation prior to sending it.
__________________
1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.

New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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  #4  
Old 07-11-2014, 11:37 AM
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Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
Posts: 259
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There are advocacy and lawyer groups out there. MCRA helped with mine. They worked with my Dr first, preparing appeals on his behalf to send for my case. When that was exhausted, they included my info and sent the final one to the external reviewer.

Every insurance has a different appeal process. I believe my Dr and his staff use several advocacy companies for the different insurances.

Early on, I contacted the attorney that won the Cigna case. They are in CA. I never heard back. But I also know the case they won they had done pro bono. There is protection for insurance companies in that if they get sued, they are only required to cover the cost of the benefits (or provide the benefits) and the plaintiff is not entitled to any compensation above that, so hiring an attorney would be strictly out of pocket cost because there won't be any settlement above the benefit cost to cover attorney fees.

A class action suit I'm sure would be somewhat affected by this but for those like you who have covered the cost personally and are seeking reimbursement I think it would be worth it.
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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