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Cigna says that Colonoscopies are 100% covered unless...

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Ulcerative Colitis
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Posted 12/6/2012 10:47 PM (GMT 0)
My Cigna insurance says that preventative care, which includes colonoscopies, is 100% covered with no deductible. I have a colonoscopy tomorrow morning. My doctor told me that when they called Cigna, they told him that my colonoscopy will have a very high deductible that I have to pay out of pocket. I called Cigna and they said that since I have Ulcerative Colitis, it is no longer considered a preventable treatment and that's why I have to pay so much.
I've paid $300 a month for this insurance over the past four years that I've had them. Do I need to hire a lawyer? Would I even have a case?
Posted 12/6/2012 10:55 PM (GMT 0)
No, you don't need a lawyer, you need (and I hope I won't get flamed for this) a reality check. Colonoscopies are "preventative treatment" for those who have no bowel problems; they are recommended after a certain age as a preventative treatment against colon cancer...one of the largest killers in the US. Since you have UC, and your Doctor wants to perform a colonoscopy to see what is going on, this is NOT preventative.

Forget the lawyer; you have no case; and BTW...$300 a month is not very much for health insurance in these times. Consider yourself lucky you only pay $300.

Posted 12/6/2012 10:57 PM (GMT 0)
huh?

his insurance pays 100% for preventative treatment but doesn't want to pay when he has a problem for real. w.t.f?
Posted 12/6/2012 11:03 PM (GMT 0)
Somedude...a colonoscopy is no longer "preventative" in this case. I don't mean to sound harsh, but that is the reality of insurance companies.
Posted 12/6/2012 11:04 PM (GMT 0)
my insurance is the same and it sucks. if you already have a bowel disease, it can't be prevented so it is just a regular check-up procedure.
Posted 12/6/2012 11:05 PM (GMT 0)
BTW...when I was trying to quit smoking 3+ years ago, my insurance company would not pay for "Chantix", but they would pay for lung cancer surgery....totally absurd...but it is the times we live in.
Posted 12/6/2012 11:06 PM (GMT 0)
My colonoscopies are screening for colon cancer. It's no different from anyone else. It's still preventative because I don't have cancer.
Posted 12/6/2012 11:08 PM (GMT 0)
bananagirl,

You are right; it sucks. But insurance is big business! If they can keep you healthy, they loose less money. Once you are ill, you are a "problem". I don't say I agree, but I accept "reality" and make my decisions from there.
Posted 12/6/2012 11:09 PM (GMT 0)
Power33...in our eyes...but, for the insurance companies it makes a BIG difference.
Posted 12/6/2012 11:11 PM (GMT 0)
Let's face facts, folks. Insurance companies want healthy people, not sick people. Get your head wrapped around this concept. You will wind up complaining less and making better decisions for yourself.
Posted 12/6/2012 11:19 PM (GMT 0)
I appreciate the replies. I'm thinking that I should save myself thousands a year and drop my insurance. They never pay for any of my doctor visits anyway since I never go over my deductible in any given year.
Posted 12/6/2012 11:25 PM (GMT 0)
Power33
I, too, have CIGNA insurance (secondary to Medicare).
I retired from a company that offers CIGNA retiree insurance.
I've called with the same question and gotten information about 100% coverage even after explaining that I was having a csope 6 months after the last one. Personally, I have little confidence in the people who answer the phones at both Medicare and CIGNA.

Final result: I had to have satisfied the $500 (CIGNA) policy deductible. Then they picked up a portion of the amount Medicare didn't cover.
Because the provider had agreed to accept negotiated amounts for the services provided, my liability ended up being nil. I was very surprised. I didn't know what to expect until I saw the final statements.
I just knew I had to have the colonoscopy. I have since had another one this year. It should be interesting to see what happens with the new claim.

The only advice I can offer is to read your policy so you understand related provisions. Can you go through a Human Resources department if your insurance is through work?
They may have a better explanation about your policy provisions and might advocate for you if you need to challenge CIGNA's response to your situation.
Posted 12/6/2012 11:32 PM (GMT 0)

Power33 said...
My colonoscopies are screening for colon cancer. It's no different from anyone else. It's still preventative because I don't have cancer.

I agree with this, and I would really take a close look at your policy (the one with all the fine print, not the summary) and see what it says. People with UC have a higher risk of colon cancer, and any autoimmune disease puts you at higher risk for other assorted problems, AND UC can change and develop needing different treatment - like enemas for lower inflammation, pills for higher up, or both.

If you have an abnormal pap and you have to be screened more frequently for cervical cancer, that isn't excluded. Your state will likely have laws on this as well - things are different from state to state.

Pull out your policy, write a letter (I like to call them nastygrams), and send it to the complaint department. Better yet, spend 3 hours on the phone and get a body on the phone in claims, get their ID number, and send the letter directly to a body. Make sure your GI codes the thing correctly - as screening, not just for kicks to see what is up there, and if you coordinate with your insurance at least SOME should be covered.

If they won't cover, I would spend the $100-$200 for a consult with a healthcare law attorney (NOT a medical malpractice attorney - totally different!) and see if you have a case.

And now, the disclaimer: this is not legal advice, I'm not licensed in your jurisdiction, blah blah please consult a lawyer licensed to practice in your state with expertise in your area of concern, you are not my client, if you track me down and call me I cannot help you, this does not create an atty-client relationship, and, big brother bar association, I am not attempting the multi jurisdictional practice of law - just trying to point someone in the right direction.
Posted 12/6/2012 11:50 PM (GMT 0)
Have you already had a scope this calendar year?  Many plans will only cover one year, and it's not prevention after that. 

You mention a deductible.  Any chance you can make it higher and lower your premium?  When I had a high deductible plan, I never met it, but my payments were about half of yours.  I kept it so that a catastrophe didn't bankrupt me.

Posted 12/6/2012 11:53 PM (GMT 0)
I ran into a maybe similar situation years ago (before UC). My hematologist's office is in a hospital. I got a very expensive infusion in his office (which was in a hospital) and the insurance company denied paying for it and applied it to my deductible, saying I got the treatment in a doctor's office. If it had been in a hospital it would have been covered 100%. I sucked it up and paid the $1500. I told my doctor about it about a year later and found out that his office could have coded it differently to the insurance and they would have covered it. Since it had been over a year he really didn't want to mess with re-doing it.

I guess what I am trying to say is, "Why are you getting the colonoscopy"? If you are getting it to check the status of your UC then your insurance has a point that your UC is not preventable anymore. If you are getting it to check for cancer, the cancer is preventable since you don't have it yet. If your doctor's office will allow you to code the procedure to looking for cancer then maybe it will be covered. I would at least run that theory by the doctor tomorrow.
Posted 8/6/2017 3:04 AM (GMT 0)
Be very careful when getting a colonoscopy if you have Cigna insurance, they will scam you and deny coverage if something is found and the doctor has to remove something. Total bullsh!t, you would be better off to tell your doctor to leave the tumor alone unless you want to pay $10,000 or $15,000. I will never get another colonoscopy again, ever.
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