By MATTHEW HOLT
It’s laborious to think about however I could now be in possession of the stupidest letter I’ve ever obtained from an American medical health insurance firm–-and I’m the man who acquired 5 equivalent letters on sooner or later from Blue Defend of California telling me that they’d modified my main care physician once I had initiated the change.
A bit of backstory. As these you’ve been following together with my numerous telenovelas could do not forget that final 12 months I used to be recognized with a failing coronary heart valve. I even have a failing left knee due largely to snowboarding right into a tree 24 years in the past.
I used to be trying to place off doing something concerning the coronary heart valve for so long as potential as a result of it sounds painful and unsightly, and I hoped that I may go forward with a knee substitute in order that my snowboarding can proceed apace. My docs are at UC San Francisco they usually agreed that I ought to have the knee substitute on July sixth, assuming that my coronary heart valve had not acquired a lot worse. On June sixteenth I went into UCSF for a bunch of knee substitute pre-workup they usually additionally checked my coronary heart.
Nonetheless, my new insurance coverage firm, because of my spouse’s new job, is Cigna. These of you in California could know that Cigna was having an enormous dispute with the College of California Well being system and that its contract with them was as a consequence of expire on June the thirtieth of this 12 months. Why a well being plan and an enormous supplier group have contracts that expire in the course of the 12 months when the employers and individuals who use the well being plan community purchase them on an annual foundation beginning in January I don’t know – and it’s ridiculously silly. However let’s not get distracted trigger I’m not speaking about that right here!
Due to the truth that they’d be out of community, the ortho group made the apparent suggestion that I transfer the knee substitute a bit of earlier, In reality it was deliberate for June the twenty second. This didn’t upset me an excessive amount of as you will have seen that some corrupt Italians have organized a soccer event that may give me loads of video games on TV to be entertained by whereas I used to be mendacity round recovering.
Sadly one of many pretests I had on June sixteenth was an echocardiogram that indicated that my coronary heart valve was in even worse form than it had been earlier within the 12 months. After numerous forwards and backwards between the cardiac group, the knee group and the anesthesia group, everybody agreed to place off the knee surgical procedure till we found out my coronary heart.
In the meantime someday late on Thursday the twenty fifth or early on Friday the twenty sixth of June, UC Well being and Cigna stepped again from the brink and got here to an settlement that can proceed the UC system being in Cigna’s community.
Which all brings me to July sixth once I obtained a letter from Cigna
That is the one which accommodates extra stupidity per sq. inch than every other communication I’ve had from an insurance coverage firm.
First issues first; Cigna has a semi-decent web site which I’ve accessed on many events. Cigna is aware of my e-mail. Cigna is aware of my telephone quantity and likewise that I can obtain a textual content from them.
The letter was dated June twenty fifth however I obtained no e-mail, no textual content, no service pigeon message on that date. And if you happen to go to the messages part of the web site which I’ve copied for you beneath you’ll see that the one communication they’ve despatched me exhibits that I can get deal on becoming a member of a health membership. Though sadly the native one I take advantage of isn’t on this deal….
So we’ve established they may have communicated with me on June twenty fifth however as a substitute I obtained their letter on July sixth.
What did the letter say?
Nicely to be useful I’ve scanned a model of it for you beneath
The primary extremely silly factor is that they despatched me a letter. This value them presumably relatively greater than sending an e-mail or a textual content and it additionally arrived after the interval mentioned within the letter had ended.
The subsequent extremely silly factor is that they instructed me that UCSF was not of their Community on 6/25/2026. That is flawed. Even underneath the contract that was about to run out UCSF was in Cigna’s Community on 6/25/2026 and was going to be for one more 4 days.
Now I’m undecided if the following extremely silly factor was Cigna’s fault or UCSF’s. Apparently UCSF had requested Cigna to cowl the surgical procedure I want, which is an aortic valve substitute and by the way in which includes me being on a heart-lung machine which doesn’t sound like plenty of enjoyable.
However what’s extremely silly is that the accepted efficient dates for this had been June 30 by means of July the 4th. Now there are two issues price figuring out about right here. Despite the fact that it was most likely nonetheless the case that on June twenty fifth when this letter was written UCSF was about to be kicked out of the Cigna Community on July 1st, on June thirtieth they nonetheless had been within the community. So for the letter for say they had been out of community when it was written was flawed. And because it seems UCSF continues to be within the community now.
The second extremely silly factor is that at no stage did I’ve scheduled or deliberate to have surgical procedure in these few days (June 30-July 4) for which this approval was efficient. I’m additionally fairly sure that nobody at UCSF thought I used to be going to have surgical procedure on that date largely as a result of on June thirtieth I really had a coronary angiogram as continued prep for the surgical procedure. A surgical procedure deliberate for a date to be named later this summer time. The angiogram was not the process talked about on this letter.
Lastly, though Cigna has accepted this process, albeit for a date on which it was by no means going to occur, they accepted it at an out of community charge, and acknowledged that there was a most quantity that they are going to pay. Very helpfully on the second web page of the letter it says that “I could possibly lower your expenses by seeing a well being care supplier who’s in my community” and “to see a listing of those professionals I ought to take a look at the Cigna web site”. It then scolds me by telling me that I selected a well being skilled who isn’t within the community. After all they’re not telling me how a lot they’ll pay or how a lot much less I’d pay out of pocket if I went to an in-network supplier.
Besides in fact I already was and now am doing precisely that.
So to sum up.
- Cigna despatched me a letter that took 11 days to get to me versus sending an e-mail or textual content.
- The data within the letter was incorrect concerning Cigna’s supplier community
- The interval for which it accepted the requested process was additionally incorrect
- And that interval ended 2 days earlier than I acquired the letter
I suppose we must always congratulate them on getting the process roughly appropriate
It might be churlish for me to level out that Cigna’s CEO David Cordani acquired paid $23 million {dollars} final 12 months. I can solely assume the Cigna board compensation committee was not rewarding him primarily based on the extent of accuracy of the customer support his firm offered. However it’s not clear what essential providers his firm or its medical health insurance opponents really do present.
And it might be equally churlish for me to level out that nobody else on the planet exterior of the US has to cope with this.
Matthew Holt is writer and creator of THCB
