Thursday, October 1, 2009

Update: Dawn Smith

Still has her brain tumor, still desperately petitioning CIGNA to approve the surgery doctors have been waiting for two years to perform. She's on pain medication while she waits, and now, CIGNA has jacked the price she has to pay for that medicine from $10 to $1,115.

From Dawn:
I'm at the end of my rope. What CIGNA is doing to me is—well, it's outrageous.

I have a brain tumor. Doctors are ready to help me. But CIGNA has been blocking me from getting testing and treatment for two years, while almost doubling my premiums.

Then, this week was the kicker. CIGNA's pharmacy called to say that the co-pay on the medicine that helps control my debilitating head pain is skyrocketing from $10 to $1,115. That's not a typo. They're making me pay one hundred times what I'm paying now, in addition to my $753/month premium.

I can't afford that. So when the pain comes, I won't have any defense. I'll spend hours in the fetal position, out of my mind with pain.

When my story went public a couple of weeks ago—with the help of over 100,000 MoveOn members—CIGNA said they would pay for a test I'd been asking for at Cleveland Clinic. It was a step in the right direction. But after two years of denials, and with a long course of treatment ahead of me, I knew better than to just take them at their word.

So I asked questions. But they wouldn't offer any explanation for why they denied my coverage for so long, or any assurance that they had changed their procedures so I wouldn't face the same unjust denials again. And I began to wonder if they were more interested in just sweeping my story under the rug than actually helping me.

When I got this latest news from CIGNA's pharmacy on Tuesday, I kept asking myself, is this a mistake? Or is this happening because I went public with my case? Are other CIGNA customers receiving the same phone calls?

I used to give CIGNA the benefit of the doubt, but after years of unexplained denials, I've had enough. So I'm asking for your help again. For myself, and for everyone else who is suffering, I am asking CIGNA for answers.

And I think it would help if thousands of people like you were to join me in demanding them. I'm writing them a short letter with a simple question: Why? Can you add your name to my letter?

click here to sign the letter

Here's what I've written to Dr. Jeffrey Kang, CIGNA's Chief Medical Officer:

"As you probably know, your company has denied me needed care for two years while I suffer from a debilitating but treatable brain tumor. I pay my $753.47 premiums. I follow the proper procedures. But CIGNA refuses to give me the care I need. Instead, you keep increasing my prices. First my premiums rose by hundreds of dollars, and now my prescription costs are going up by more than 10,000%.

"What makes you think you can treat sick people this way? When will you stop doing this to me and the thousands of people like me who are suffering? And if you solve this latest problem, how do I know you won't do this to me again next week—that you're actually changing your ways and not just trying to make your PR problem disappear?

"Please answer these questions. I need to know, for the sake of my health and my life. Many others have signed this letter too, to support me and make sure I get answers."
Thanks for all you're doing. I don't know where I'd be without your help.

Most sincerely,
Dawn
Please, please, please. Help Dawn Smith.

2 comments:

tpkatsa said...

I've read a few posts on Dawn's case this morning. Although there are many posts on this issue, this is one of the few so far that allow comments (thank you).

My question is, has a copy of the health insurance policy against which Dawn claims that CIGNA is denying care been posted anywhere online? Has it been determined that CIGNA is in breach of contract for not providing this care? If so, has Dawn sought legal advice?

I'm not an attorney but it seems to me that if Dawn has been paying her premiums the insurance company is legally obligated to pay for care provided that care is covered in her particular insurance policy.

As this has been going on for two years one has to assume that Dawn's been down the legal route but since I'm new to this issue I thought I would ask.

Ku said...

My understanding is that the terms of the policy are not explicit to the degree this situation demands. You may be familiar with the infamous "pre-existing condition" clause; this has been invoked by CIGNA (among other companies) in the past to exclude treatment for tumors that likely began growing at some point in time before their policy came into effect upon the insured. There is also a "non-critical" clause in some higher-risk policies, which allows the insuring company to refuse treatment for conditions that their own physician consultants deem less than critical, such as benign tumors, joint replacement, correction of mis-set bones, etc. I suspect this or some related clause is being leveraged against Dawn's doctors' recommendations for treatment.

It is nigh impossible for a relatively healthy individual (let alone one debilitated with a brain tumor and the pain associated with it) complainant to achieve access to the council and requisite funding for a legal dispute with a company the size of CIGNA. Add to this the consideration that communications with a large corporation are often very slow and one can easily spend two years or longer trying to resolve an issue.

It is likely that with additional funding and assistance, there are still further legal avenues for Dawn Smith's to carry her case against CIGNA. (There always are.) However, I imagine she cannot pursue these any further on her own, in her current condition.