My Son, Depression, and Cigna
This is the time of year when I have the best ideas for blog entries. I’m on my bike a lot, and as I ride, funny and interesting thoughts seem to just occur to me, usually a couple of them per ride. The biggest challenge I have is remembering all the ideas long enough after the ride that I can jot them down to do the post on later.
I currently have a backlog of 18 post ideas; it makes sitting down and actually writing this blog so easy, because instead of the “what should I write about today?” question, I get to choose which idea I want to write about.
So this morning I sat down and started doing the Photoshop work for the post I wanted to write (illustrations were necessary for this idea).
And that’s when I got the call from Cigna, the insurance company my employer uses.
Cigna says that as of today, they will no longer cover the program my son is in to help with his severe depression.
And obviously I am no longer in a mood to write anything funny at all.
A Little About Depression
Depression comes hand in hand with cancer. One of the things I haven’t talked about in this blog (but will in my Fight Like Susan book) is the depression Susan had to battle after she finished treatment the first time she had cancer.
It was around that time that my son started showing signs of depression, too.
Now, many years — and doctor visits and therapists and psychiatrists — later, he’s still fighting depression, which has only become worse, to the point that it is essentially debilitating.
A Program That Works
But I recently found a program that was helping. A comprehensive program, with academic, therapeutic, and psychiatric aspects combined. For the past two weeks, he’s been there eight hours a day, five days a week.
His progress hasn’t been fast — you don’t overcome depression fast — but it has been progress, for the first time, ever.
And that’s where the phone call from Cigna comes in. They believe he doesn’t need this level of treatment. It isn’t medically necessary. Visits to a psychiatrist and maybe a counsellor should be sufficient.
Right, because that’s been so successful so far.
No Help
Today we did what is called an “expedited appeal,” which is where the doctor that’s working with my son talks with one of Cigna’s doctors and tries to convince the Cigna doctor that my son actually needs the help he’s getting — that it’s not just for entertainment or free babysitting or whatever.
The Cigna doctor turned down the doctor caring for my son immediately and easily, saying that since my son is not in “imminent danger” — he is not actively attempting to kill himself — this level of care is unnecessary. A weekly visit to his therapist should do the trick.
Right.
Please Help
So now we’re at the next level of appeal. The doctor caring for Brice isn’t particularly hopeful; Cigna seems to be pretty comfortable with the word “no.”
After that, I have to start looking at other options. Raiding my 401K. Asking parents for money. Telling my son I’m sorry, but he’ll just have to soldier on as best as he can. After all, it’s not like depression is a real disease, and it’s not like he has cause, right? Buck up, kid.
OK, that last sentence started letting the anger and bitterness out a little bit more than I wanted. I’m going to leave it in there just so you can see what I’m trying to hold back here.
So, maybe you can help. Maybe you work at Cigna, or know someone who does. Or maybe you might want to email them or tweet something to @Cigna and @Cignaquestions.
I don’t know if any of that will help. I really don’t. Maybe it will even make things worse for me.
But this is my son.
And this is what Cigna is supposed to do.
And they’re not doing it.
Comment by DavidV | 07.23.2012 | 1:56 pm
Happy to help in anyway I can. Good luck!
Comment by Jim Bovinet | 07.23.2012 | 2:04 pm
I watched Blue Cross do the something similar to my mother when she was diagnosed with cancer over three years ago.
There is nothing like listening to a functionary tell you about the medical care of your loved ones. And people wonder why a lot of people like the idea of a health care system a la European nations.
Keep up hope and keep fighting.
Comment by jm | 07.23.2012 | 2:06 pm
This tears me up. And with all the self-awareness of a mosquito, I acknowledge a similar situation is the reason I commute to SLC from two thousand miles away. Utah has the crummiest insurance laws. I am bitter for you.
Comment by Janneke | 07.23.2012 | 2:06 pm
Sh*t. There’s not much I can do from here but have sympathie. And think of you.
Comment by Jennie | 07.23.2012 | 2:11 pm
I don’t know if I can help in any way, but I just wanted to express my sympathy to you. I struggled with depression for years as a teenager (and in my early 20s) and it’s definitely a ’second-class disability’. People who haven’t experienced the crippling physical, mental, and emotional pain that depression causes don’t understand it. I’ve been told by numerous educated people to ‘just let it go’ or ‘just move on’. They don’t understand that having depression actually changes your brain chemistry, making it more difficult to get out of the depression.
I hope you find a way to get them to cover the treatment or an alternative way to pay for him to get the help he needs.
Comment by Ingunn | 07.23.2012 | 2:16 pm
As someone who has been through and still struggles with depression (which has severely affected my life), I am enraged and disgusted by this. I guess mandated insurance for all doesn’t help much when they can still screw you over like this.
Lots of good thoughts to you and your son.
Comment by mark @ GRAVELBIKE | 07.23.2012 | 2:16 pm
Get in touch with the folks at http://www.twloha.com/ They might be able to help you.
Comment by RevBigRing | 07.23.2012 | 2:16 pm
Sorry Fatty. I know all to well how crippling untreated depression can be, I wouldn’t wish it on anyone. Even a Cigna executive
Comment by Fred | 07.23.2012 | 2:17 pm
I’ve always wondered if they literally make you sell your soul before you can go to work for an insurance company.
So the doctor, who works for Cigna, who gets paid by Cigna, and who has never examined your son, decided that he doesn’t need the treatment.
Given how impartial he would be in this situation, I’m amazed that that’s the decision he came to. Shocking.
Cold hearted b@st@rds.
Comment by Laura | 07.23.2012 | 2:17 pm
Wow. Let him know he isn’t alone. And I hope Cigna gets it together. That’s just cruel and irresponsible of them. Maybe suggest they meet you at least halfway? Certainly more than one visit a week. That’s minimal for someone who isn’t debilitated….
Comment by Henrik Wist | 07.23.2012 | 2:21 pm
Fatty,
in all seriousness, I think you can always start a fundraiser and for once keep the money for something like this emergency. I’m sure people would throw in a buck or two.
Comment by Deb Mc | 07.23.2012 | 2:23 pm
So a kid has to be in imminent danger to get the help he needs? How about helping him now so he never gets to that stage? Idiots.
Comment by Keith | 07.23.2012 | 2:24 pm
E, As a broker/consultant of insurance my recommendation would be to get help from your company’s HR dept and, even more so, the broker. Insurance companies make impactful decisions based on what the bottom line tells them because the costs to care for “lifestyle choices” has spiraled out of control. So the less used services like depression and other conditions take a back seat to other more predominant issues. Sad, but true. Your company’s insurance broker, if he/she is worth anything, should act as intermediary for you and fight this fight. That’s why your company pays them X$ in commission every month. Brokers place lots of business with CIGNA, the BLUES, Selecthealth, whomever, and may have the ear of certain people within the company. The carrier may still say no, even if the situation is appealed, but then they understand the risk that the broker, who represents them, will find other solutions or move this business to a more responsive carrier come renewal time! Our intervention on behalf of clients has helped carriers to change their minds in the past and while I can’t fix every problem, its better for those that we do win on as they continue to get the care they need. Don’t fight it alone! Leverage the broker.
Comment by Gillian | 07.23.2012 | 2:27 pm
Ditto to the insurance broker. I was an HR Manager before I became a lawyer, and when my people came to me saying that our providers were – get this – NOT PROVIDING – I’d immediately call my broker. My broker was able to do more for us than anyone else, because my broker had a lot of buying power.
I shame-tweeted, also, for what the hell that’s worth.
Comment by Jennt | 07.23.2012 | 2:28 pm
This is just disgusting. I hope your son can continue to get the help he obviously needs and is helping. Seriously Fatty, you have done so much for the cancer community, that if you had a fundraiser for this, I bet many hands would reach out to help support you and your family. Ours included.
Comment by Doug (way upstate NY) | 07.23.2012 | 2:30 pm
Elden, that sucks and tears me up. Unfortunately, living with a wife and father who are social workers I know you story is not unique. I sincerely hope that you reach someone at Cigna who understands and listens.
The one thing that we would suggest (which is obvious and you probably already tried) is taking the tack that you have tried the recomended treatment for YEARS and it isn’t working.
Comment by ScottR | 07.23.2012 | 2:32 pm
Dealing with my son’s medical needs over the last year or so has caused me to despise insurance companies far beyond what I ever thought possible – best wishes for you and your son.
Comment by Jeremy G | 07.23.2012 | 2:35 pm
HR Broker route. I had a massive billing issue (provider and insurance company could not decide what bill should be so provider tried to send me to collections to collect my house). My HR dept got broker involved, broker and I spoke, I handed over my information and my side of the story. Within one week the claim was pulled from collections and provider was paid by insurance company.
I know my story does not compare to yours, but we all have dealt with depression of loved ones and know how horrible it can be. Talk to your HR dept and ultimately the broker. The Cigna paid doctor is not impartial nor fit to decide if Cigna should pay for this service.
Comment by ClydeinKS | 07.23.2012 | 2:36 pm
Be a thorn in the side of their “expedited appeal” and don’t be content with the their comfortableness for denial (I know you’re not). I seen denials from insurance companies where the response for a necessary treatment was considered “a luxury by all insurance companies and you don’t need it” get turned around by persistence.
When there has been a push for preventative measures, it makes no sense for stopping rehabilitative processes from improving the current status or preventing further debilitaiton.
I am an awful climber but would love to help with the pull over this uphill battle. Take this one head on and stay in big ring. WIN!
Comment by Barefoot Rose | 07.23.2012 | 2:37 pm
My children haven’t needed the kind of services your son needs but there was a time afte a serious eye injury and infection when my insurance wouldn’t pay for the injectable antibiotics. Long story short – the HR department at my work made a few short phone calls and suddenly I was getting back thousands in drug costs. It’s definitely worth trying before going broke.
Comment by ChinookPass | 07.23.2012 | 2:38 pm
criminals.
Comment by Christina | 07.23.2012 | 2:45 pm
That sucks.
Will definitely tweet @Cigna later. I’m a Cigna customer (by force…our formerly excellent insurance got bought out) and am shocked at their “Do you have a case number I can help you with?” autoresponse they’ve been giving you. I’ve been at the bottom of that well and am thankful I made it back out.
Comment by dude | 07.23.2012 | 2:47 pm
Your american health care system (or almost complete lack of it) sucks big time. Move to Europe or start a social revolution or both! Maybe you’ll have more impact than the Obama dude in this particular field.
Revolution!
Comment by Superstantial | 07.23.2012 | 2:47 pm
@APAPsychiatric is the American Psychiatric Association and @AmerMedicalAssn is the AMA. Seems like physicians’ organizations have a vested interest in 1) getting paid and 2) having their medical determinations count for something.
We’re all hoping for a good result for Fatty’s family.
Comment by Nurse Betsy | 07.23.2012 | 2:48 pm
Sorry to hear this Fatty. My prayers are with you and your family. As a nurse, I hate insurance co. They don’t think in the mind set of prevention. Preventative medicine would save this country and these companies so much money. I think what Keith said is a good Idea. I’m also in favor of a fundraiser. You have been so generous with others, I know we would all be willing to be generous with you and your family.
Comment by Sjw503 | 07.23.2012 | 2:50 pm
You’re in Colorado correct? Have you called your state Insurance Division yet? I would also contact your state legislator and request assistance as an elected official’s office can open doors a little more quickly. Your employer may also want to know the plan they purchased blows goats. Finally, if the National Alliance for the Mentally Ill has a chapter in your state they may have some advice for you on how to get your son into the program. I hope you get this resolved very soon.
Comment by aussie kev | 07.23.2012 | 2:55 pm
I just posted my dissaproval on thier face book page – they seem to have a lot of disgrunteled customers.
why would you have a facebook page and combine it with bad service !!!! – it lets the whole world see your dirty laundry !!!
Allez Fatties Son
Comment by Andy | 07.23.2012 | 2:58 pm
I don’t personally know you but I know you are a fighter and I’m guessing your boy is too. This is a hard battle to fight, and that’s why you have my support and prayers. I have fought it and still am. You guys keep you heads up; you have your reader’s support.
Comment by h | 07.23.2012 | 3:04 pm
Hey, hate to hear about your troubles. I know what it’s like to try to help someone with depression, and it’s definitely not an easy row to hoe.
Suggestion: Though your son isn’t in “imminent danger”(thank God), feel free to let the Cigna doctor/representative know that you will do your best to hold him/her personally responsible for any consequences of this denial of medical care. Even if he is contractually free of individual liability, the fear of the massive stink that sort of outcry(‘lawsuit’) would create for him and his company could work in your favor. Be the proverbial squeaky wheel and hope for the best.
Comment by Penina | 07.23.2012 | 3:04 pm
I wish I could help you with more than just sympathy and understanding. I personally fought the same fight for myself with a different company many years ago…and now I know that when my 16 year old teen needs it, I can only provide what I have been able to get out of my insurance company…I watch like a hawk to make sure she does not take a nose-dive.
Comment by Ross | 07.23.2012 | 3:07 pm
I de-privatized my twitter account to ensure they would see my messages. I wish I could do more to help, but snarky tweets will have to suffice for now.
Comment by Cat_Rancher | 07.23.2012 | 3:12 pm
I am so sorry. This is a terrible thing on so many levels. Depression is emotional cancer. As the mother of an autistic son, I understand the helplessness and sometimes rage watching your child go through something you can’t really help with and having people tell you he doesn’t really need what you know beyond a shadow of a doubt he needs. As others much better at this than I have said, go to your broker. Would the program itself work with you? When my dad, a small farmer with no insurance other than VA benefits, was sick; the hospital (with a little help from a pro bono lawyer ;) ) really worked with him on costs and a plan. Let the Fatty nation rise up- we’ve worked for cancer, camps, bikes for Africa, weight loss, and pie awareness; surely we can take on part of this battle, too. We are with you, just as you have been with all of us. Take care, because we care.
Comment by robanjo | 07.23.2012 | 3:19 pm
So sorry for their rectal cranial disorder. My thoughts and prayers are with you and the fair lad.
Comment by Skye | 07.23.2012 | 3:19 pm
When I rule the world, I’ll save us all from insurance that doesn’t help much (and a bunch of other stuff too), but until then…
I try to remind myself that I’m happy to have any insurance now instead of none, but some days its hard to believe myself. I’m diabetic and get to fight for something stupid every year (stupid to have to fight for, not stupid to have), and I’m sorry I don’t have anything more useful to offer besides hang in there, sometimes things change.
Comment by Jim B | 07.23.2012 | 3:23 pm
My wife suffers from depression and she has often said that someone needs to invent a new word for it. Everybody has been depressed about a break up, or a lost job, the kind of thing you get over in a few weeks or months. But clinical depression is more than just the blues that won’t go away. People who haven’t experienced it or its consequences think that the sufferers of clinical depression just need to buck up, but they have no idea what they are talking about.
Good luck Eldon & son. If you have a fundraiser I’m sure your readership will step up, even if the plan is to take the money and tow an airplane banner past Cigna headquarters with a rich epithet.
Comment by Jerry | 07.23.2012 | 3:28 pm
Posted to my facebook wall and to Twitter with #helpFatty tag. Maybe we can get that trending and get some unwanted attention on Cigna
Comment by Clair | 07.23.2012 | 3:28 pm
My battle with depression in the 15 months since my mom died has been fraught with insurance fights. I can’t imagine going through that with a child. Good luck!
Comment by Jerry | 07.23.2012 | 3:30 pm
And onto Cigna’s FB wall
Comment by BJG | 07.23.2012 | 3:33 pm
http://www.insurance.utah.gov/complaint/index.html
If you haven’t already, file a complaint with the UT insurance commissioner
Comment by Sharon G | 07.23.2012 | 3:35 pm
I’m so sorry to hear about this- it’s shameful. Depression runs in my family and in my husband’s family and I have seen how crippling it can be. My husband suffered from severe depression in the years after he had cancer- it didn’t require the level of care your son needs but it wasn’t easy to find the right solution.
I can’t offer anything but moral support but I do hope you will follow all of the suggestions you get here and that your son continues to get the intensive care he needs.
Comment by Steven | 07.23.2012 | 3:45 pm
In college I had to stop treatment for depression because insurance would not cover the full cost and I did not have the cash to keep going. I have been depression free for a number of years now, but am still bitter about the “service” I received.
Comment by Bec Shreck | 07.23.2012 | 3:47 pm
Your situation totally sucks; I’ve been there and I know how maddening it can be. Any medical care that is required five or more days a week has limits in any insurance program ~ usually something like 27 days total; even in medicare and medicaid, AND you still pay for a good deal of it. After that, you pay for it all. This is true for the dying; this is true for the sickest of the sick; this is true for the mentally ill. I lost all of my saving and transformed my entire life while caring for a sick loved one. It is hard to accept, but it is likely you will get poor too if you continue this treatment for your son (I know, but how can you not when you see evidence that it is working!) Start limiting your spending NOW; move into a smaller place, put yourself on a tiny monthly allowance, sell one of your cars, your extra bikes, do whatever you can to make some extra cash. My husband has suffered from bipolar disorder in the recent past; he was severely ill. Two years later, I am entirely grateful to his counselors and psychiatrists because he is now completely under control and happy; I would have never thought it could happen but we found the right people for him and this was the key to our success. It was impossible for us to get more covered care than a weekly psychiatric or counseling appointment; this required an incredible amount of patience; in-between sessions he might be screaming from a squatting position in the corner of a room for hours – sheesh. His illness required having my family come and stay with us for two months during bad times to assist with his care so I could still work to support our family. Unfortunately, insurance only covers two appointments a week for a psychiatrist and counselor – another if you get your primary care provider in the mix; I have never head of any different situation with any insurance. This is as much as they will do unless you commit your loved one. I did not commit my husband, but don’t be afraid to if your son is in danger of injuring himself or others. Also, be VERY aware if any secret drug or alcohol use are in the mix because these can make it extremely difficult to get an accurate diagnosis and proper treatment. Good luck.
Comment by Jason | 07.23.2012 | 3:55 pm
Been a long time since I posted any comments. But this is too much. It’s as if they are saying someone has to actively try to commit suicide before they will offer the service that could have prevented such actions.
You are a good person and your family has already been through so much. You deserve a break from the health/medical world.
Your blog has brought cheer and happiness to so may people. You have a large and generous audience who would surely be happy to help out.
Comment by Lori P. | 07.23.2012 | 4:03 pm
I’m with Nurse Betsy on this one. I am also a nurse (who hates insurance companies)and have worked not only in the US, but for a short time in Canada, so I can appreciate the drastic differences in health coverage that exists. In addition, I have had difficulties with Cigna regarding my youngest son, who has Asperger’s (a form of autism). As a parent, nothing will make you more upset than something that affects your children in a negative way! Sadly, I can only sympathize with you, but know that you have all of us on the interwebz behind you. Bring on the fundraiser!
Comment by blair | 07.23.2012 | 4:20 pm
Ask your company’s CEO to call Cigna and say he’ll shop around for another provider if they don’t cover needed treatment for sick people.
IIRC, it worked for this cyclist I know, who’s since done alright for himself and a few million others…
Comment by will | 07.23.2012 | 4:42 pm
I’ve watched my wife suffer through breast cancer and battled depression most of my life. It’s horrible!! I will be thinking of you and your son and wishing you well. Don’t give. I know you won’t. Peace, will
Comment by Jeff | 07.23.2012 | 4:43 pm
I have never posted here, but read every day. As a father of 3, I find this maddening! I truly respect your ability to hold back, and not just write the flaming post I am sure you are thinking.
That being said, with all of the fundraisers you good you have done for others, I am sure there are many of your readers who would like to participate in some way financially to help your son continue he treatment. Don’t let pride get in the way, make it work for everyone. Maybe half of all donations go to your son, and half to Livestrong, something like that.
We’ll all be watching to see how this turns out!
Comment by Heidi | 07.23.2012 | 4:43 pm
We came through for your nephew when he needed help, and we’ll come through for your son. Put that donate button up there!
Comment by Julie | 07.23.2012 | 5:09 pm
Previous posters are correct: Get thee to thy HR department, and quick. Complain, loudly.
If that fails and your plan is actually insured by CIGNA, Utah Department of Insurance.
Comment by RMK | 07.23.2012 | 5:17 pm
I feel your pain. My husband’s company was sold three years ago, and we were shifted from an excellent insurance program to Cigna. My recommendation to you is to find a health care lawyer, now, today. As long as they are talking to you, and not a lawyer, they won’t do a thing. *Their* only fear is lawsuits, and the earlier you can introduce that fear, the shorter your struggle will be.
Good luck.
Comment by BradO | 07.23.2012 | 5:33 pm
You may also want to determine where Cigna’s doctor is licensed. The state where he or she is licensed may have ethical rules against making medical diagnoses without personally evaluating a patient. This is a rather aggressive approach and may lead to nothing, but it’s one potential avenue to pursue. Hit ‘em where it hurts (his license), they sure don’t mind doing that to you.
Comment by RodNeeds2Ride | 07.23.2012 | 5:37 pm
You know how I feel Elden. Fight tooth and nail, then if needed call in the FattyCalvary!
Comment by Becky | 07.23.2012 | 5:38 pm
I am no fan of insurance companies, or lawyers for that matter. My daughter has battled depression and will be at risk the rest of her life. It is criminal the way you have to pay and pay and then when its time for them to pay they find a way not to. criminals.
Comment by Karen | 07.23.2012 | 6:09 pm
Have you heard of Heather Armstrong – dooce.com – she has battled depression for years. Lives in Salt Lake City, very vocal and knowledgeable about depression. Did speech at ribbon cutting ceremony for new University Neuropsychiatric Institute in SLC – may have connections that could help.
Comment by Blake J. | 07.23.2012 | 6:48 pm
My thoughts go out to you and your son. Similar to others here, I struggled with depression during my teens and early 20s and can relate. Best of luck, Fatty.
Comment by briebecca | 07.23.2012 | 6:55 pm
You may be able to work something out with the excellent program your son is currently in. Perhaps do a fundraiser for them? I think a lot of us would contribute. Organize a charity ride that benefits them only. Something like that. It’d bring them more PR and $. Another tactic to try is to find out the real costs of the treatment. The prices sent to insurance companies are often inflated. Best of luck and hope your son hangs in there.
Comment by M | 07.23.2012 | 7:24 pm
Similar situation here when my daughter was in treatment. Chemo injected into her spine caused spasms…botox injections, believe it or not, helped. BUT our inusrance would not cover…so I had our Dr. write a letter stating that if she did not get the botox she would have to be admitted monthly after each spinal so she could be administered a morphine drip- which would cost less, botox injections or a week hospital stay once a month. We won. Not sure how you could coordinate this, but perhaps the Dr. could write that the harm cuased is going to be a greater cost than the dollar saved.
Good luck- this isn’t easy.
Comment by Brandon | 07.23.2012 | 7:31 pm
You might consider a petition on Change.org or another site. There a quite a few where people gather signatures to force the insurance companies to do something, and many have been successful. I have a feeling you could gather more signatures than most.
Just a thought. Best of luck.
Comment by Hergules | 07.23.2012 | 7:53 pm
Yup… our healthcare system is broken and we (i.e. Congress, Insurance Companies, Care Providers) continue to try to fix it by managing payments instead of managing care…. yes, it’s a lot more complicated than that…. or is it? Hey Cigna… start a trend and do the right thing.
Comment by Paula Webb | 07.23.2012 | 9:00 pm
Have you tried reaching out to Heather Armstrong at http://www.dooce.com? She suffers from depression, writes about it pretty frankly on her blog, plus sits on a governmental panel regarding healthcare. I bet she might have some ideas for you.
Comment by AKChick55 | 07.23.2012 | 9:02 pm
This makes me so upset. My mother has suffered with depression – debilitating depression as in she won’t eat, get of bed, change her clothes, bathe, etc. – since I was very, very young. I recently went through an extreme bout after she almost died from pneumonia and the hospital (against policy I found out much later) discharged her without a care plan. They asked me what my plan for her was – I said, plan? She was perfectly fine before she went into the hospital – I have to work – what is YOUR plan? The social workers were horrible. It too two months of my uncle and I going in daily and forcing her to eat, drink, bathe, me washing her clothes, changing her sheets, cleaning her bathroom, washing her before i was able to find a long term care coordinator to help me fine a personal care company. Unfortunately, she’s on medicaid and medicare, though in Alaska, our medicaid is pretty good. The problem is that you can’t get a waiver for mental illness (yet) so I am fortunate that she qualified for some hours during the week. My mom is still trying to get back on her feet mentally and it’s been 9 months. We are extremely fortunate in Anchorage that we have a mental health center for low income individuals that is pretty good and that has helped keep my mom functioning. I know firsthand how important it is to have a program that works. It makes a HUGE difference. I thank God every day for everyone that helped me find assistance for my mom because I don’t know what I would have done.
I’ll do my part, but I would love to have a fundraiser to help you, someone that has helped so many so cheerfully and with such grace and humor. One of us is going to organize something to help you offset costs until Cigna gets its act together. We love you guys and we want to help, so let us. Please.
Comment by Fuzz Martin | 07.23.2012 | 9:08 pm
I also snark tweeted. I noticed that they have since deleted their responses to your tweets, which means they are now in duck & cover mode. At least they noticed. I hope that you can leverage their new, unwanted press into having them make a new, responsible decision regarding your son’s health and wellbeing.
Comment by RipkenLady | 07.23.2012 | 9:20 pm
Hi, I work for a behavioral health HMO and I will tell you to be the squeaky wheel. Typically there is at least one more appeal level to pursue, read your denial letter carefully. Call and leave messages with the medical director, the clinical director, anyone who will talk to you. Let them know you are a blogger, no one wants this PR. If you make enough noise, I bet they reverse the decision or at least work with you. You can request copies of the medical record and see what information they used to make their decision and see how that compares to the medical record the provider is keeping. Heck, call your legislator if you are passionate. I can’t tell you how many times we have processed complaints from politicians on behalf of others. No one wants the bad PR. Be the advocate your son needs you to be and don’t give up if you are passionate!! In the mean time, have your son see the therapist and MD as they recommend and get those providers to advocate for a higher level of care and to tell the HMO why a lower level of care is not sufficient. Best of luck to you!
Comment by Maggie | 07.23.2012 | 9:21 pm
Unfortunately, Cigna isn’t the only insurance company doing this. It appears to be the norm and we have been through something similar with my daughter. I would continue to contact them, write letters and call as much as you can. My daughter was hospitalized – we had taken her to the ER when she was out of control and violent. She wasn’t threatening to kill herself or anyone else but they admitted her for further testing and admitted her to their program. This was when she was in Junior High and she actually had school as part of the program because she was there for several weeks. Long story short, or long:), the insurance refused to pay because we didn’t have pre authorization! We fought this for almost a year and the insurance company ended up paying. It was very stressful, which is the last thing you need when faced with something so serious. This isn’t quite the same but I would continue doing whatever it takes. I wish you and your son well. I know the struggle you are going through!
Comment by UT Lawyer | 07.23.2012 | 9:35 pm
Cigna’s obligations are defined in your insurance policy, which is just like any contract. If they are denying coverage, it is because there is something in the policy that they feel supports their denial of coverage. Their position might be strong, or it might be extraordinarily weak. I couldn’t say without knowing what the policy provision at issue says. Your best bet is to consult with an attorney to evaluate your rights, and Cigna’s obligations, under the policy. Assuming you have a solid legal position (denying coverage by itself does not prove they did anything wrong) a well-written and well-reasoned demand letter may do the trick to get them to see the error of their ways. If not, you will have to decide whether it is worth litigating over. Lawsuits are filed all the time over whether residential-type treatment should be covered or not. If you would like, I would be happy to point you to someone who may be able to help. Best of luck.
Comment by Sue Dayton | 07.23.2012 | 10:37 pm
Don’t give up the fight. as parents we have a pretty good idea when a treatment is working. As the mother of a son with Aspergers, I can tell you that advocating to get services and support for your child makes a huge difference in what services they receive. Keep it up!
Comment by Linda | 07.23.2012 | 10:39 pm
Let us help you Fatty. You’ve brought so much joy to our lives, let us raise some funds for you. No giveaways, no prizes, no promises. Just let us help.
Comment by zac_in_ak | 07.23.2012 | 11:03 pm
I tweeted to the @Cigna account and I hope they are getting a tweetful.I just got insurance this month and feel for how horrible this must be. I hope they reverse their decision and your son gets the care he needs.
Comment by Anonymous | 07.23.2012 | 11:38 pm
What a frustrating post to read today. To think that individuals in the richest, most powerful country in the world are made beggars at the feet of the insurance companies.
I believe Team Fatty will win every fight they take on, but I feel for the many others without the resources, the support group, and the platform Elden has, as they fight their own individual battles against a system and insurance companies that values people only as profits and costs.
Elden, you’ve seen it done first hand:
FIGHT LIKE SUSAN!!!
We’ll be there with you.
Comment by davidh-marin, ca | 07.23.2012 | 11:43 pm
Sorry Fatty, I was using a different computer and missed my ‘name’ above.
Comment by Fat Chick on a Bike | 07.24.2012 | 5:10 am
Even Christopher Reeve at his level of prominence talked about constant insurance battles he had to fight. The Hammer has talked frankly that you aren’t very good at details. If that’s true, you need to fight that tendency first. You need details – the details of Cigna’s mental health coverage, the basis for their review process (all their review process – internal and external), whether they do arbitration or ??. It sounds like a situation where prolonged “reasonable and customary” treatment has been ineffective, thus it’s reasonable to try more intense treatment. You need facts his doctor can help you get – treatment success rates on your son’s program, treatment success rates for your son’s condition (not overall depression, for his subtype). You need facts of the treatment program – how is it being billed to the insurance company? It is possible the insurance company might pay for some but not all of the program. Don’t count on the doctor to have necessarily been the most effective advocate here. Interview him to find out what his arguments were in the expedited advocacy process so you know how to go beyond them. Do whatever you need to do to keep your son in treatment right now – the most dangerous time for depression sufferers is where their depression has improved to the point where they have energy for self harm but not yet improved to the point where that doesn’t seem like an option. Ask the billing department of the program your son is in to work with you to establish a payment plan you can manage while you negotiate through the claims review process. Ask your employers healthcare benefits rep for help identifying your options in Utah and see if your HR program can refer you to an insurance appeals specialist – there are people who know the ropes and can help you and they may be worth it. Good luck.
Comment by Graeme | 07.24.2012 | 6:09 am
Fatty,
I don’t know much about the US healthcare system or Cigna, but you may try reaching out to Clara Hughes, who is pretty much the pride of Canadian athletics. She’s been open about her battle with depression and does a lot to fundraise and increase awareness, and would no doubt appreciate the similar work you do for cancer. She’s got a pretty big stage right now with the Olympics a week away.
http://sports.nationalpost.com/2012/02/08/a-look-back-at-olympian-clara-hughes-battle-with-depression/
Good luck!
Comment by Tes | 07.24.2012 | 7:22 am
This breaks my heart. How can we help you?
Comment by Full Monte | 07.24.2012 | 7:37 am
I have Cigna.
They suck. The worst insurance company ever. They are case-in-point why we need Obamacare. Why we need oversight and choice. Because Cigna is the embodiment corporate greed and heartless accounting practices.
My wife is a psychologist. If you were near me, you’d bring your son to her. She is kind, experienced, effective. She hates Cigna, too. She gets to deal with them from the caregiver side as well as the patient side.
Get the Cigna doctor’s email if you can. Perhaps we can start a letter-writing campaign to that Tw*twaffle.
Comment by Mark J. in Dallas | 07.24.2012 | 7:53 am
I know your aggression is at Cigna but this is typical of most insurance companies – certainly the ones I am familiar with. Their first response is always “no.” That was the basis of John Grisham’s “The Rainmaker” years ago – Big Insurance and how they make profits. It’s extremely unfortunate and a sad state of affairs that these companies are primarily interested in making profits for their shareholders. You have an uphill battle. Good thing you have a small army behind you. Just look at the number of comments in a relatively short time frame for proof.
Comment by Sara | 07.24.2012 | 8:10 am
Link shared.
Comment by Geo | 07.24.2012 | 8:58 am
I’ve seen depression’s effects on a teen first-hand with a close relative and know it is not easy on everyone who cares about them.
And not to get too political but will make this point about insurance companies.
When the debate was going on for the government healthcare plan the opposition kept saying “you don’t want a government bureaucrat making your care decisions” while completely ignoring the fact you are facing now — an employee of the insurance company who has the company’s bottom line to watch out for is making your care decisions.
Comment by Jac | 07.24.2012 | 9:15 am
I asked a friend who works for Cigna for advice, Several readers have offered the same thoughts but the email includes some additional ideas. I hope it helps.
“If the plan is self-funded, going to her HR or benefits administrator would be an option. I would keep appealing up the chain, over the medical peer to peer that appears to have been done already.
The medical director is Joel G Caschette MD. Who reports to Alan Muney, Chief Med Officer
In cases where treatment is outside plan guidelines or limits, sometimes an attorney is needed”
Comment by Lyle | 07.24.2012 | 10:22 am
Good luck, Fatty.
My thoughts…
1) Keep fighting! Call the broker! Be persistent!
2) This is why we need a single payer healthcare system
3) With your Livestrong fundraisers, I’ve given, $10, $20. I think I’m not alone in saying I’d give way more to a fundraiser for your son’s healthcare.
Comment by rich | 07.24.2012 | 10:26 am
not much to contribute but sorrow for what you’re dealing with. We’ve dealt with my wife’s depression for years and I know its not easy…
Hang in there, keep fighting and let us know how we can help.
I like the fundraiser idea…I know you probably won’t want to do a fundraiser that benefits you directly, but this would also be about raising awareness for this overlooked, often mis-diagnosed and continually mis-understood disease…
Comment by Rob L | 07.24.2012 | 10:37 am
Cigna is a pain, but they’ve been better to me than BCBS over the years. Family has been through similar issues and it’s terrible man. I’m down for a trip to Conn for a Ride On Cigna. Not sure where these jerks are your dealing with.
Comment by davidh-marin, ca | 07.24.2012 | 10:37 am
Elden,
Like you said earlier, you saw Susan deal with depression and her cancer. Does LIVESTRONG have links to advocates and advice that might help in this situation?
Comment by Hautacam | 07.24.2012 | 10:40 am
Fatty & son —
No matter what happens with Cigna, a whole boatload of us have got your backs.
We are here for you.
Comment by BonzoGal | 07.24.2012 | 12:03 pm
This may be controversial, but here’s my experience: A good friend had a drug problem. She went to her doctor and was told that drug addiction counseling was not covered by her insurance unless she was suicidal. She thought about it for a couple of days, and then went back to her doctor and said, “I’ve been contemplating suicide.” Boom, all her counseling was covered.
She had to lie to get help, which sucks. And it’s probably now on her permanent medical record that she was once “suicidal”… but she figured that since it was already on her record that she was severely depressed and was seeking help for drug abuse, one more thing couldn’t hurt. And she ended up getting the help she needed.
(This really was a friend, not me. She’s fine now, thank goodness.)
I agree with everyone who says to try the HR Dept/Broker route, too.
Comment by sam | 07.24.2012 | 12:12 pm
Do contact your state’s attorney general and whatever department regulate’s insurance companies. You may get some assistance.
Comment by Jackie | 07.24.2012 | 12:13 pm
I work in the healthcare industry and this is par for the course with regards to Cigna. They are experimental this and not covered with that diagnosis that. Some suggestions: Media…you’ve got a great story and I’m sure the media would eat this one up…also, contact Utah’s state insurance commissioner office and file a complaint. Those corporate docs are all about the company bottom line. They make decisions that benefit the company, not the patient that they incidentally have never seen. (the son that you love). In my experience, it never hurts to mention the word attorney, too. They tend to jump at that. Best of luck to you.
Comment by davidh-marin, ca | 07.24.2012 | 1:19 pm
Since I don’t tweet, and when AngieG asked me to ‘text’ her in sent a letter, let me ask Cigna this;
@cignaaskquestions when Greenlight Capital (a $7.6B Hedge Fund) announces they are taking a ‘position’ with Cigna, who does the company respond to….the insured, or the money men. Thought so.
Check Bloomberg Capital News for announcement today of Greenlight’s investment.
And politically…it’s not Obamacare or Romneycare…it’s called Healthcare, and ALL Americans should have access to it.
Comment by Nick | 07.24.2012 | 1:29 pm
Fatty,
I’ve been fighting depression for years now. As another commenter said, it’s like a cancer of the mind. Insurance companies are evil, but you are uniquely suited for this fight. Failing that, we’ve got your back.
Comment by MikeG | 07.24.2012 | 2:25 pm
Fatty – we feel your pain, or at least a little bit of it. We have been playing this sad game with United Healthcare for our 8 year old sons stuttering problem. They refuse to pay for any therapy, period. Never mind the fact that he spoke normally until the middle of 1st grade. They claim his speech did not develop normally/completely. go figure…We have tried everything short of raiding retirement – that’s the next step. Hang in there, we are all pulling for you and yours, and we share your frustration and outrage!
Comment by Judith | 07.24.2012 | 2:54 pm
Fatty-
I wish I had words of encouragement but I do not. It was a year and half after our 17 year old son’s suicide that Cigna finally was forced to pay our coverage by an Independent Review Organization. (IRO) It took an independent group of doctors to admit and see our son’s needs one and half years after he took his life. Cigna never agreed our son’s needs were medically necessary and were only eventually forced to pay with the IRO appeal. I cannot express the degree of anger we felt when we were told our son’s needs(residential treatment program) were not medically necessary.He suffered from a combination of depression and asperger’s syndrome, which made his life exceedingly difficult and despite all the signs of the need for full time care, Cigna refused payment. We felt helpless and cynical, knowing that with every phone call we would be forced to explain to Cigna doctors who knew their answer to the question before they even got on the phone with you. Mary Covington, at Denials Management,(in Utah) was a huge help to us. I have related to many of your posts because our son’s facility is in Draper. We would walk in Corner Canyon on some of our weekend visit time. I felt some vindication when Cigna was finally forced to pay however the loss of our son pales in comparison to our “win”. None of the insurance companies care about your son. He is a statistic with a dollar bill attached to his back. Despite all the negativity in this post re insurance companies, please don’t give up the fight. Ultimately it is your son that matters above all else and your fight for him is one small reflection of your love and caring for him as a father.
If writing about your frustrations helps, then by all means write. Appeal, appeal, appeal….even while watching your life’s savings slip through your hands. Your past speaks to how you know the value of life and you know how to fight. Many families are in similar situations to yours, but the enormity of the insurance companies makes your appeal and your son’s needs minor. Hard to believe when you live it every day, isn’t it? Cigna didn’t cause my son’s death but their refusal to help us financially contributed to his death as we were unable to continue residential treatment after 13 months. We pulled our son out of treatment, tried to make our home a 24 hour treatment facility and ultimately failed. Insurance companies don’t care no matter how strong a case you think you have. However, don’t let them off the hook. Get some support and help and fight the good fight. My son loved bikes-he was able to build a bike from the frame up with tools and parts. We miss him so much. He had a great sense of humor and bikes were an escape for him. Unfortunately, ultimately his mental illness trumped all else. Wishing you the best….
Comment by Patrick | 07.24.2012 | 2:58 pm
I’ve politely tweeted them just now, let me know if there’s anything else we can do, you’re family has been through enough, and you’ve done more than enough to help and inspire others to bigger and brighter things than to have to go through this now.
I love America, but I am very grateful for the NHS here in Britain.
Comment by Toby Marshall | 07.24.2012 | 7:44 pm
Hi Fatty,
I’ve never written in to something like this before, but you need to hear me. I, personally, have suffered with depression. I’ve attempted suicide in the past. What helped me the most is “cognitive therapy.” Dr. David Burns is a genius. He has a series of books called “feeling good, the new mood therapy”. He sees patients still and I velieve he is on the East coast. I’m a physician and treat depression daily. This is the only scientifically proven treatment of depression in the country. Dr. Burns is not the only proponent, just the best. You need to get your son in to see him. I really believe his life depends upon it! I don’t know if you’ll ever even read this, but having suffered for years from depression, I know how important this is. Don’t hesitate to contact me. I can help. I hope he gets better.
Comment by Evo | 07.24.2012 | 8:10 pm
Push it baby, push it. Once they know you won’t go away you have a better chance at progress. Learn the system and use it. Good luck my friend.
Comment by Jay | 07.24.2012 | 8:34 pm
You need to hire a lawyer and have a demand letter with notice of bad faith claims handling prominently discussed. I would be honored to hook you up with one of the best in the country (no, not me…)
Comment by GenghisKhan | 07.25.2012 | 7:19 am
Hey Fatty’s Army. Can someone with more technical and marketing ability than I simply start a donation page so we can get some fund-raising going? Something along the lines of the Karen Klein effort?
Then, if the insurance company pulls through, Fatty can convert the funds to a LiveStrong, World Bike Relief or whatever campaign. If not, then there’s a bit o’ cash to help Brice.
Someone?
Comment by Tiff | 07.25.2012 | 9:02 am
Fatty, I’ve been following your blog for years and rarely comment – I don’t even ride a bike! I’m in Australia and can’t do much, but I will be praying for Brice, you and the rest of your family. Your frustration & sense of urgency are palpable and justified. I pray you’ll see positive results very soon and look forward to reading an update.
Comment by Patrick | 07.25.2012 | 11:01 am
Fatty, so sorry to hear of your son’s condition. It’s a serious health issue that’s often disregarded/neglected by insurance companies. Actuaries like clinical studies that support their decisions, like pills and surgeries. Not all mental health treatment works the same with patients.
I for one can’t understand why this country seems to have so much distain for “Obama Care” while totally glossing over the failures of our current system. I’m not so much a supporter of the President’s plan as bewildered the failures of our current system have been forgotten.
Personally, my insurance offers terrible coverage yet costs $930 a month (family of 5). Fortunately, that’s only 9-10% of the household’s gross revenue. That percentage would be double if we were “middle working class income”. Just image if the premium were called a “tax”, and a tax that increased 10% per year. Would that draw any attention from my GOP friends? (I’m a pissed off political independent)
Comment by TimD | 07.25.2012 | 12:59 pm
Sorry to make light but its the only way Scouser’s know to cope. I think what you need is a new Magic Quadrant published. Instead of the normal criteria we could have humanity and ability to help as the axes.
More seriously, get your HR dept and whoever does your corporate insurance deals involved. Pressure and/or bad press from such a prestigious customer count for lots.
To those looking over to Europe with longing/envy, I’m sorry to say that, at least in the UK, mental health comes a long way down the pecking order. We have had basically the same response as Eldon, unless there is an imminent danger either to himself, others or their property, our son was pretty low down the priority list.
Hope things get better, I really do. Can’t offer much advice but we can offer lots of sympathy. Feel free to email.
Comment by BigD | 07.25.2012 | 2:00 pm
Sorry to hear about this, I retweeted the link and let me know what else I can do.
Comment by KB | 07.25.2012 | 4:35 pm
I’m sad to say that I’ve had a similar experience with Cigna. I’ll send an email on your behalf. I ended up paying by myself… and I’ve experienced depression so I know how very very debilitating it is. You don’t deserve this so I hope with all my heart that Cigna sees the light.
Comment by Ed | 07.25.2012 | 8:51 pm
You must remember that the last thing an insurance company wants to do is pay. The bigger the hit the more they drag their feet. We have dealt with insurance companies for many years and the least of their concerns is the needs of the insured. Insurance companies will always deny big claims first, second or third go around. Something like 70-80% of the insured will give up and go away, that is what the insurance company is counting.. But I have seen, many times, insured individuals that will not take no for an answer and will not let the insurance company off the hook and believe it or not they end up paying. So my advice is to keep after them, be the bulldog that you are and do not give in. Remembe, the greasy wheel gets the grease.
Comment by dana | 07.26.2012 | 12:35 am
i just wanted to let you all know…that things worked out very well..well i should have told u this out for along time..as a matter of a week ago..but i wanted to give this comment out when i was fully confident that things are working out… Brianna is back wid me..our relationship is just like before the first time we met, do you need his help here is the man that help me email address wiseindividualspell@gmail.com to contact him.
Comment by Bill | 07.27.2012 | 3:23 pm
Sorry if this is repeat info that someone else has already suggested, but my eye’s started to hurt reviewing all the responses (you’ve got a lot of fans you fatty!!),
However, since you’ve already gone through the Cigna medical review, have you contacted Cigna about an independent review yet?
http://www.insurance.utah.gov/health/IndependentReview.html
best of luck, I hope this situation gets corrected.
Fat Willy
Comment by Oliver Wilson | 08.8.2012 | 3:25 am
Be very careful with taking both ‘natural’ medicines and prescription medicines for depression. I experienced Serotonin Syndrome after taking both SAMe and Ginko Biloba, as well as the prescription drug Elevil. The Wikipedia article on Serotonin Syndrome says that it can also be experienced with St John’s Wort, Yohimbe, and Boswellia, as well as a number of other drugs (both legal and illegal)
general health