THCB

CIGNA and Me

I have a challenge for CIGNA CEO David Cordani.  Sometime this week, pick up the phone and be a secret shopper.  Call your customer service team and ask them the same thing I asked them on a Friday not long ago: does my plan cover and reimburse for flu shots, and at which participating providers in my area?  This is managed care and wellness 101.  Just not at CIGNA.

Customer service rep A says shots are covered and reimbursed, but she cannot confirm any place in St. Louis as a par provider that would bill the plan directly for payment.  Her stubborn refusal to grasp the meaning of “par provider” was infuriating.  She repeatedly reads a list of potential providers (all national companies, such as Walgreens) and then tells me I must call each location to discern its billing practices.

Wrong.  Just plainly and simply wrong because they’re all signed to national contracts.  Then, while both my German Shepherds headed for cover in another room, she hung up on me.  (I was angry but never profane or malevolent.)

Undaunted and now even more frustrated, I call customer service again.  Customer service rep B says: shots covered fully and each location noted previously is a par provider that will accept assignment.  Done, right?  Not yet.  Customer service rep A calls me back.

She has not, however, learned anything in the intervening 15 minutes, as she returns to her home base of ignorance with the accuracy of a GPS.  Finally, I demand a supervisor.  With the supervisor comes enlightenment and lower blood pressure.


The supervisor acknowledges that I am 100% correct.  All the entities named by rep A are par providers.  The problem is that they are also all pharmacies, and counter service people in some locations erroneously billed the flu shot to the pharmacy benefit rather than the medical benefit.  Hence, CIGNA enrollees were wrongly coerced into paying up front and submitting a claim.  Inexplicably, this information has not been shared uniformly with the customer service team or their care partners, but my volcanic tutorial has now made her realize she needs to do so.  Wow.  Ya think?

So, Dave, answer this for me.  If your people can’t get something this simple straight, as we are well into flu season and the unleashing of hell, er, I mean health reform, how can anyone take seriously that you and your ilk are actually going improve the nation’s health?  Success requires doing small things well, even flawlessly, because that’s how you set the stage for success at bigger things.  Like being a triathlete, right, Dave? Tell us about how you’ve done in the 125 triathlons you’ve completed when you took the little things for granted.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is also the Wellness Editor-At-Large for THCB.

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17 replies »

  1. My wife is in A Fib. Cigna says that our heart surgeon is covered. On second visit for stress test they call back and say the doctor is not on our plan. After 2 hour wait they finally agree to cover the procedure. We can afford the best insurance but decided to go through health. gov to sign up. What we signed up for we did not get and did not know until now. Good bye Cigna and Health Care.gov.

  2. Philosophically, I believe that any good or service that one has a *duty* to consume, such as vaccinations, should be free. That said, how in the world could you justify using your time trying to get a health insurance company to cover a routine expense that is only tens of dollars?

  3. So what are we going to do about Insurance companies. Doctors and Hospital that lie and cover up botch surgeries and deny
    proper medical review for those patients, I’m sure their are those in the medical system that know what I’m talking about.
    Like this one, (((( Robert W Robninson vs Cigna Health Care , Dr Gary Gartsman of the Fondren Orthopedic Group , The Texas
    Medical Board , Dr Angela McCain , Aetna Health Care , The Texas Insurance Board. ))) Now these people can deny this all they
    want and like they always have been. But this one thing they can never do is to prove Robert wrong by challenging Robert in
    public over his complaints. What is worse than cancer? Doctors and Hospitals and Insurance companies that will lie and
    cover up medical mistakes. How sad it is to know tha this sick way of thinking still goes on with are so called elite in
    our health care system, the very ones that advertise how great and caring they are.

  4. Cigna’s customer service team should review the concept analysis I’ve just completed on service excellence 🙂 Health and wellness has been continuously promoted, and being that we are in the midst of flu season full on, these situations should not have occurred. With something as simple as this situation, it can make us feel shaky about the future of healthcare. It is believed that the lower income population and women will benefit most from the changes in health care. With preventative care services, equal insurance prices for both men and women, and no limits on preexisting conditions, I would say that’s a pretty good start considering the contrary (Kaiser, 2013).
    However, it’s one thing to have preventative care service coverage, but one should not be charged. I’m curious to know if Cigna is planing to reimburse their clients that were charged for flu vaccinations erroneously. I am a healthcare employee and received my vaccination at work, but I am also a Cigna client. This could have affected me if I had not received my vaccination at work.

    http://kff.org/health-reform/fact-sheet/obamacare-and-you-if-you-are-a-woman/

  5. As select provider groups/insurers get this sort of mundane but important probelm fixed, the traditional insurers will get ever more squeezed. Sort of like the domestic auto industry ignoring quality and fuel economy (and green/hybrid) for years and years and years. Except there don;t appear to be any too-big-to-fail health insurers.

    Mihgt be a good thing. Perhaps a good way to fix allof the bad systems is to let the worst of the lot fail.

  6. Beyond the ‘Managed Care 101 fail’, think how corny and superficial this branding notion is… They know better, or do they?

    It doesn’t even sensibly build nor leverage Stanford’s landmark lifestyle values work nor even Maslow notion’s of what actually drives people.

    Yikes!

  7. I am all for yelling. Don’t be profane. Don’t threaten. But, people would be surprised at the results achievable with a some carefully aimed heat.

  8. I hear you and that was the point of the post. Simple should be done simply. That would help so much to relieve administrative burdens and smooth the process of giving and paying for care.

    I get that in complex care — cancers, heart disease, massive trauma, complicated pregnancies and delivery — there are transactional elements worthy of oversight and review. As much as we don’t like to admit it, there are plenty of crooked physicians and hospital administrators who both steal money and hurt people. Invest the time and energy in addressing those things, but they are at the margins in terms of frequency. The no-brainers should require, well, no brains.

    If they really wanted to make this simple, I should not even have had to call customer service. I should have been able to log on, enter my id number, and have a list of par providers pop up instantly with the message…”See one of these providers and your bill will be covered and paid in full, and if they bill incorrectly, because this is covered service, we’ll resolve it with them without involving you.” Done. No, that’s too sensible. Thanks for the note PCD.

  9. You just had to go through this farce one time regarding a flu shot. This is what a physician and her staff have to go through hundreds of times every month just to get paid for work that was done weeks ago.

  10. Vik, thanks for great post. So many people can identify with this problem thread….lack of listening, lack of full knowledge about a product or service, and lack of vision or mission.

    Hospitals are facing horrendous hurdles to improve patient perception of care…as well as the outcomes of that care. We got into this mess because the focus was on “the money” and focus remains on “the money”. It is simply coming from another angle now.

    It is time for the public to speak up….in fact yell….that there is no cohesive vision for patient centered care. How much money has been spent already on the .gov health exchange site….and what will it cost tax payers to fix it? As a long time clinician I can only think of how that money could have improved care coordination, made aggressive moves for improving our infection rates and so much more.

  11. Lynn: thanks for your note and sorry for your friend’s travails. For way too long, American health care consumers have let both providers and plans delude us into thinking that their nonchalant approach to customer service is the standard. And we take it, which we would not do from any other commercial vendor.

    All the academic hand-wringing over quality/service is nothing compared to frustrated consumers taking their dissatisfaction to the web like I did today. The health care system is too big for us to keep swallowing their nonsensical tripe that they’re doing the best they can. They aren’t.

  12. Customer service continues to define oxymoron. Unfortunately in health care it can be dangerous and expensive. I’ve spent the better part of a week trying to untangle a friend’s hospital discharge instructions that is riddled with errors. Guess what, there is NO phone number to call if you have question about the hospital discharge instructions … patient is own their own. And we wonder why patients are readmitted.

    If you never expect customer service, you are never going to be disappointed. But occasionally you might be surprised when you stumble on it.

  13. Right on, Rick. Wrong incentives, wrong business model, wrong leadership, wrong communication skills, wrong (and overdone) political influence. Shall I go on?

  14. Vik – I once met Leonard Abramson -founder of US HEALTH CARE-
    http://en.wikipedia.org/wiki/Leonard_Abramson
    Most Phila area Docs viewed him as the devil incarnate for being a pioneer in managed care. I tried to defend him for at least trying to do SOMETHING about our broken system. Since then I have come around to your own views of managed care. Right idea – wrong incentives.

  15. Indeed it is. It is a great example of the stupidity inherent in the managed care industry, which has, since the 1980s, tried to convince us all that they can improve health, contain costs, streamline administrative headaches, AND generate a return to shareholders. Grades: F, F, F and A.

    And, now, of course, the managed care industry has pivoted to wellness, which, as our readers know, is just more managed care. Gee, good for us.

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