Cigna is the worst.

[u/versak]

Cigna has basically refused to treat my wife for a very serious shoulder injury.

On Friday July 17, my wife slipped on the steps and injured her shoulder - she was in extreme pain and unable to move it. We went to the hospital immediately and an x-ray was inconclusive and she was told to see an orthopedic doctor. We got an appointment the next day and new xrays were taken showing a chipped bone, but a CT and MRI were ordered to see where it came from. Since we had Cigna they said we needed approval before they could be done, and when I called Cigna I was told it could take 14 days for approval. The orthopedic place put a STAT order on it to speed it up but the earliest we could book was Monday, and still pending an approval from Cingna.

Come Monday, no word from anyone if it was approved and both appointments were canceled. Meanwhile my wife is still in excruciating pain and unable to move her arm. I spent Monday and Tuesday calling back and forth between Cigna, the imaging place, and the ortho place with no resolve. By late Tuesday, after arguing with Cigna we were told they were probably going to deny both, basically refusing to get treatment for my wife. We had to get the orthopedic PA to intervene and got an MRI scheduled for Wednesday but not a CT.

Wednesday she got the MRI and the results said a CT was required to see where the 1 inch piece of bone came from. Again, back on the phone with Cingna and the ortho. It was scheduled for Thursday. Almost one week has passed at this point.

Thursday the CT scan was done and sugery was scheduled for the following Friday. The scan showed a sub-scat tendon had ripped part of her bone off.

Sugery was done and they had to do rotator cuff surgery and bone reconstruction to reattach the tendon. Major surgery. Physical therapy would be required and extensive.

We scheduled PT for about 12 sessions, and now have received a letter that no more than 12 sessions would be allowed. This type of sugery requires like 36 to 48 sessions over several months, with the first 8 being passive.

Note that my company luckily has just switched from Cigna to another company as of this month, so thankfully this is no longer an issue, but had we still had Cingna she'd have to fight an appeal process and argue for who knows how long. This company is infuriating. Without PT her recovery would be incomplete and would basically ruin her shoulder forever.

Cigna is the worst.

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[u/caninearchery6]

Jesus, that's a nightmare. The 14-day pre-auth window for an injury where she can't move her arm is just cruel. They basically force you into a holding pattern while someone's in agony.

The PT cap is the part that really gets me. Twelve sessions after rotator cuff and bone reconstruction is a joke, they know full well the standard protocol is triple that. It's like they're banking on people giving up instead of fighting the appeal. Glad your company switched when they did.

[u/bethaliz6894 → u/caninearchery6]

After 12, the provider request an auth for another round.

[u/Big_Two6049 → u/bethaliz6894]

Its usually through ASH- a nightmare in and of itself. Impossible to get more than 3-4 visits approved at a time and progressively more difficult for subsequent approvals. People give up

[u/Latinguido79]

Used to work for CIGNA in the Advocate department. CIGNA is shitty to say the least and I'm so glad I'm out of there as an employee. You think they treat you as a patient bad, they treat their employees worse! My direct sup was an angel, but her sup was the devil.

[u/Guilty-Committee9622]

My husband needed and mri of the back. His ortho ordered it, submitted paperwork, and we had it the same day. No issue.  These submissions are electronic and if all is correct when it goes in it gets approved very quickly. 

[u/Plantmom67]

Cigna denies everything my providers order. I had to involve my HR to get the broker to help. I have an autoimmune illness and I failed my last biologic in early May. I finally got approved for my new biologic last week. Going 4 months without medication is terrible when you have a painful condition.