This has been happening to me for the past several months.
1. Cigna will not tell you for any reason, why the claim is denied
2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial
3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT code for therapy is the same as the equipment code for injections.
So one claim processor decided that the claim was for injections and denied it. Then every subsequent claim has been denied under the same reason.
4. At this point the only option for me is for my provider to appeal every single claim (which takes months), as this is the only way to get someone to actually read the claim and make an intelligent decision.
> 1. Cigna will not tell you for any reason, why the claim is denied
Of course not. Fight fire with fire. Get care providers to sign a letter to Cigna saying the procedure is medically necessary Going through the process will not work and will go slow. But putting them on notice by having licensed, local care providers say something is medically necessary and urgent will work almost 100% of the time.
I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished health…
There needs to be something like the CFPB for health care. I couldn't get an actual human to acknowledge me when dealing with PNC when they ate up my bank, but one CFPB complaint got them to do exactly what I asked. That way you never get to the point of burning time, money, and health because they're afraid of action from the agency.
It would be the state’s insurance regulator, although do not know if they are as effective as CFPB. Financial issues tend to be much less complicated than health issues, and usually just a result of understaffing and underinvesting in customer service.
If you have health insurance from your employer, it's probably covered under ERISA. This is federal, so no help from your state insurance agency and no small claims, and I have found that there are few lawyers who will touch it even in a large city.
Also using Kagi - I like the customization how you can boost certain sites results and block or derank others on an individual level.
It does take a little getting used to vs Google, but I'd say 95% of my searches are on Kagi now. Occasionally if I can't find something, I'll use Google as backup, but for most things, Kagi is good enough.
I really appreciate this comment - when I was working on my old startup, I felt exactly the same way.
I quit my old job and was working on what I wanted to, and yet felt this resistance that I couldn't explain. The nagging doubts that I was doing the right thing, that it wouldn't be good enough, and the fact that it would be all o n me if things didn't work out.
It's definitely one of those mental roadblocks that's hard to explain until you've been through it.
As someone who has been susceptible to chronic depression, I understand completely. I've had to explore these nagging doubts with a good therapist to be able to get past them.
Motivation is still a black box for me. I have learned that of I'm not motivated, something is wrong.
> Woodworking or motorcycle repair are hard, and the initial setbacks are extremely demotivating. You won't hit the ground running, so you better prepare for disappointment.
This mirrors my experience as well - also there is a dollar cost to each try, and no undo button, which puts more pressure on each attempt.
I still enjoy doing hobby woodworking, but it's not quite as zen in the beginning as I imagined.
The joy of construction comes from the difficulty of combining design thinking with entrepreneurial financial prudence and first principles engineering to overcome obstacles that (often) arise. And then of course, translating these ideas into tangible functional art. It is very much like software engineering, but as you say ; the stakes much higher.
Also they then use SEO to get their own phone numbers and website higher than the actual restaurant's number/site, basically guaranteeing a cut of any phone/website order, even if the customer doesn't want to go through Grubhub.
I've worked remotely for the past several years, so that part has unfortunately not been a benefit for me.
Not being able to go to coffee shops/coworking spaces for socialization, as well as not seeing friends in person has really started taking a toll in terms of depression. I am an introvert, however people often confuse that for not wanting any social interaction. I do prefer to have social interaction, just with close friends and usually in smaller groups (followed by rest after).
I do realize that I am lucky to still have a job and be healthy. Still, it has been a tough time.
Learning some Vue.js - struggled a bit to get into React (nothing against React, might try it again later), but I find Vue+Typescript with class components works well for me as a .NET dev.
Web dev tooling really has come a long way in the past few years!
1. Cigna will not tell you for any reason, why the claim is denied
2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial
3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT code for therapy is the same as the equipment code for injections.
So one claim processor decided that the claim was for injections and denied it. Then every subsequent claim has been denied under the same reason.
4. At this point the only option for me is for my provider to appeal every single claim (which takes months), as this is the only way to get someone to actually read the claim and make an intelligent decision.
An absolute nightmare :(