By MATTHEW HOLT
It’s arduous to think about however I could now be in possession of the stupidest letter I’ve ever obtained from an American medical insurance firm–-and I’m the man who acquired 5 similar letters on sooner or later from Blue Protect of California telling me that they’d modified my major care physician once I had initiated the change.
Just a little backstory. As these you’ve been following together with my numerous telenovelas might keep in mind that final yr I used to be identified with a failing coronary heart valve. I even have a failing left knee due principally to snowboarding right into a tree 24 years in the past.
I used to be making an attempt 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 might go forward with a knee substitute in order that my snowboarding can proceed apace. My docs are at UC San Francisco and so they 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 and so they additionally checked my coronary heart.
Nevertheless, my new insurance coverage firm, because of my spouse’s new job, is Cigna. These of you in California might know that Cigna was having a giant dispute with the College of California Well being system and that its contract with them was resulting from expire on June the thirtieth of this yr. Why a well being plan and a giant supplier group have contracts that expire in the midst of the yr 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 crew made the plain suggestion that I transfer the knee substitute somewhat earlier, The truth is 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 yr. After various backwards and forwards between the cardiac crew, the knee crew and the anesthesia crew, everybody agreed to place off the knee surgical procedure till we discovered 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 comprises extra stupidity per sq. inch than some 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 cellphone quantity and in addition 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 should you go to the messages part of the web site which I’ve copied for you under you’ll see that the one communication they’ve despatched me reveals that I can get a very good 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 under
The primary extremely silly factor is that they despatched me a letter. This price them presumably reasonably 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 improper. Even below 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 best way includes me being on a heart-lung machine which doesn’t sound like a whole lot of enjoyable.
However what’s extremely silly is that the accredited efficient dates for this had been June 30 by way of July the 4th. Now there are two issues price understanding about right here. Despite the fact that it was in all probability 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 improper. And because it seems UCSF remains 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 principally as a result of on June thirtieth I truly had a coronary angiogram as continued prep for the surgical procedure. A surgical procedure deliberate for a date to be named later this summer season. The angiogram was not the process talked about on this letter.
Lastly, though Cigna has accredited this process, albeit for a date on which it was by no means going to occur, they accredited it at an out of community price, 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’re going to pay or how a lot much less I might 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 knowledge within the letter was incorrect relating to Cigna’s supplier community
- The interval for which it accredited 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 right
It will be churlish for me to level out that Cigna’s CEO David Cordani acquired paid $23 million {dollars} final yr. I can solely assume the Cigna board compensation committee was not rewarding him based mostly on the extent of accuracy of the customer support his firm supplied. Then again it’s not clear what obligatory providers his firm or its medical insurance rivals truly do present.
And it could be equally churlish for me to level out that nobody else on this planet exterior of the US has to take care of this.
Matthew Holt is writer and creator of THCB
