Brave New Films’ video Sick for Profit opens with a clip of a woman, Jo Joshua Godfrey, who says Cigna cut off her coverage by telling her she had nothing wrong with her, when they knew — as she did not — that her scans showed she had lung cancer.

I would go to CIGNA and they would tell me I had bronchitis and give me medicine and send me home. Then the CIGNA Director called me up and she told me that there was nothing wrong with me at all. I called the doctor, and I came with my film and my CAT scan and he just put it in, it took exactly thirty seconds. He told me, ‘You have cancer,’ and he said the reason CIGNA did not want to give you your records is they’ve known right way back for years that you have cancer and they’re not going to treat you.” Jo Joshua Godfrey.

On September 3, 2009 the LA Times carried a story by Lisa Girion headlined State HMOs deny 1 in 5 claims, analysis shows. Girion wrote:

A nurses group says state government data show that denial rates among the five largest insurers ranged up to 39.6% in the first half of 2009. The firms caution that the figures are misleading.

California HMOs reject one out of five medical claims, according to an analysis by the California Nurses Assn. of data the companies submit to the state.

The analysis — the first of its kind based on state government-collected data — concluded that from 2002 through June 30, 2009, five of the largest insurers in the state rejected 31.2 million claims for medical care, or 21% of all claims.

Cigna responded September 8 with a press release stating that these denials were not really denials:

Payment denials do not accurately represent whether an individual actually received care. Out of all eligible requests for coverage submitted to CIGNA HealthCare of California in the first half of 2009, more than 95.9 percent were covered and the person received the care recommended by the doctor.

A closer examination of CIGNA’s Schedule G, which is filed with the DMHC and is the document CNA refers to, firmly supports the notion that the payment denial numbers have little to no bearing on coverage. . . .

CIGNA agrees that the public should know how often coverage is denied, but saying that payment denials equate to coverage denials does not achieve that goal. At CIGNA we are proud of how we administer benefit plans. In fact, nationally out of all eligible requests for coverage submitted to CIGNA in 2008, more than 99 percent of the time the services were covered and the person received the care recommended by the doctor.

On the website Pissed Consumer a post in the name of Jo Joshua Godfrey states:

The Cigna Medical Director, documented in my file theTumor was removed it was benign, and all I would need would be a follow up xray.

I stood outside this same Glendale based Cigna in a Hospital Gown fighting to live, as they would not return my calls. Instead of letting me get treatment they met me with their Lawyers, and their Risk manager.

My father was with me,and so was my husband, my Father I will never forget told their Risk Manager, if they do not let me get the necessary treatment, he would take him and throw him from the fifth floor Window out on to the street.

The Newspapers came to my aid, and after my story was published CIGNA only then agreed to pay for the treatment needed.

Jo Joshua Godfrey survived and founded United Patients of America “Our goal is to help reform the health insurance industry by identifying individual and systematic patient abuse that helps carriers dodge their responsibilities, deny benefits and delay payments,” Godfrey writes. “We want to empower patients and give them a voice, especially cancer patients and others with chronic or terminal illnesses.”

LINKS

http://sickforprofit.com/press/

State HMOs deny 1 in 5 claims, analysis shows

CIGNA Media Statement With Regards To California Nurses Association’s Claims 08 September 2009

United Patients of America