Dade Teachers with Cigna- A Must Read

By Adrian Melero Board Certified Acupuncture Physician on June 4th, 2014

Cigna Exposed !

 

As the 2013-14 school year comes to a close, and as a former teacher, I would like to recognize the hard work and dedication that teachers put in. And being in healthcare now, I am advocating for teachers’ rights to their health benefits.

 

I have heard quite a bit of disappointing feedback from Dade teachers in the last year regarding changes on how adequately their benefits are being honored. In my practice, the abuse of Cigna violations of policy and ERISA laws of non payment has reached a level where I am no longer able to accept Cigna.

 

My issue with Cigna began last summer after I wrote and posted a critical article regarding a new Cigna policy that took effect on July 1, 2013. The policy is that after six chiropractic visits, medical records are required to be submitted to have medical necessity determined by someone who has never examined the patient. This includes a new physical complaint not examined by anyone yet. Even though the patient is entitled to 40 visits under this particular policy, the first six visits seem to coincide with the approximate number of visits needed to satisfy the deductible. After that, receiving benefits is often an uphill battle.

 

Not long after I published that post, Cigna suddenly stopped paying altogether for all my patients, including a stop payment to a pair of checks already issued for claims that were properly processed. Upto this point, I had never had an issue with getting paid by Cigna in the four years that it had been with Dade schools. When I called to find out what the issue was, I was told that the treatment rendered for each patient did not match what was on the patients’ files. I replied that this was impossible. None of the medical records were neither sent. or requested upto that point.  The lady on the phone then said that it does not necessarily mean that records were reviewed but that it also means that I should send them. I was outraged. Stating that notes did not match what was done is a very specific statement and almost accusing me of fraud even though no review had taken place. I then asked the lady how can I be sure that my patient records will be reviewed honestly if a determination had already been made even before having access to records. Every single patient after that was the same statement. The whole thing seemed very dishonest.

We never-the-less sent them the medical records. Even though I am very confident about the accuracy of them, I was skeptical whether they would actually be reviewed. When my patients called Cigna to complain, they were simply told they were waiting for the records to be reviewed. They play many games. They will change multiple times the fax number that is needed to be sent to. They will say they never received it despite evidence of transmission reports. They will say there is a page missing. We have never been paid by Cigna since.

 

I am not the only one. Many of my colleagues have similar complaints. Many teachers have complaints of non payment for many different types of medical services.

 

What can be done?

The insurance for Dade teachers is self funded. This means that Cigna merely manages the policy but that the school board pays the claim. With this arrangement, Cigna is not accountable to the state department of insurance regulations. And since the school board is not an insurance company, neither are they. So how does one make them accountable? By contacting the local department of labor. When your benefits and insurance policy is not honored, it is basically as if your employer is not paying you what was agreed. If the problems with Cigna are prevalent, and enough complaints are made, this may cause an effect to be made by the school board. I also encourage people to post your story, if you had an issue with Cigna not paying for any covered medical service in the FB comments and help it go viral and raise awareness of the issues. Do not let a big corporation tread on you and your benefits that you worked so hard to earn.

Also, feel free to post how you have benefited from alternative medicine and therapies.

 

Summer Offer:

This summer my office is offering teachers a discount for our services.  For $40, during our non-peak hours, you may receive either a treatment for acupuncture, pain therapy, or 30 minute massage.

 

 

5 Responses to “Dade Teachers with Cigna- A Must Read”

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    It’s always a pleasure to hear from someone with expertise.

  • Elizabett

    eat what u want I was in horrifying pain again. So first weeks I drank alot fliuds, smoothies and are stuf like salad, applesauce, home made soups ( more veggie). And it helped cause I wasn’t eating heavy. I hope you feel better from it sooner than I did I know it was horrible and at that point the worst symptoms I had. By chance have u taken any antibiotics lately??

  • Enrique

    I think you should peesrnt your paperwork to her lawyer through your lawyer maybe her lawyer will try to convince her that she should be using your health coverage. You shouldn’t be having to pay double health care for the same issue. I wouldn’t take it to the courts unless she goes through the courts try to settle out of court. She could so rack up your medical expenses for almost anything the way it is now from braces to cosmetic surgery for your daughter whatever.At the very least, see if you can get your lawyer to restate the agreement to say, written notice must be given of uninsured expenses at least (e.g. one month) in advance of treatment, both parties must agree on treatment, in order to be reimbursed. That way you’ll have a better chance of catching treatments that could be done just as well under your plan. If she’s not paying the plan she shouldn’t be adding to your expenses needlessly. +2Was this answer helpful?

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