Hacker Remix

Ask HN: What are the best resources to help with health insurance denials?

6 points by cigna 18 hours ago | 9 comments

In late 2023, I had hospital expenses outside of the USA, and spent about $3k out of pocket. I submitted the claims to Cigna, but even though I got email confirmations of my submission, it was only until 2024 (when Zoox, the employer who the insurance was through, got involved) that I could see the claims in my Cigna dashboard.

Zoox was initially helpful in getting Cigna to respond to the claims, and they let me know what additional information Cigna needed. Cigna gave inconsistent reasons for why my claims were rejected, including saying that I needed to resubmit due to my plan being 'handled by different department', and that a 'vendor outage... prevented many of [my] claims to come through’. There have also been at least two times that I have talked with Cigna over chat, only to have the chat die after the agent asks for more and more time.

Conversations with Cigna: https://docs.google.com/document/d/1dNDsCJ0_LSed4CmCmkSPQYMA-MpDPL6vg9lVRR1rgOY/edit?usp=sharing

Eventually, Zoox stopped responding as well, though I have a followed up a few times through email.

Is there any way to get Cigna to have a good faith review of my claims? Any government agencies that can help me, or outside companies that can help with the appeal?

giantg2 17 hours ago

Your state attorney general should be able to help.

brudgers 17 hours ago

[random advice from the internet]

If it matters, hiring a lawyer might get their attention.

But while it is probably an injustice and $3k feels like real money to most people, how much are your time, and emotional energy worth?

You are up against an extractive institution with teams of professionals who spend all day, five days a week, fifty weeks a year figuring out what can be gotten away with. And their compensation correlates to how much is gotten away with.

Their phone tree can be programmed to route your call to the bit bucket when wearing you down by the runaround isn’t working. None of this is a misunderstanding, it is all by design. Good luck.

giantg2 17 hours ago

I wouldn't spend money on lawyer for consumer protection issues. I'd submit a complaint to the state attorney general consumer protection department.

brudgers 36 minutes ago

Like I said “if it matters.”

giantg2 15 minutes ago

That's not the same.

It can matter and you can get similar results through your attorney general without spending your own money. If it doesn't matter, then you wouldn't do anything.

toomuchtodo 17 hours ago

Did your plan cover out of country expenses?

cigna 17 hours ago

Yes. Some of the much lower out of country expenses, they approved, and added them to my deductible.

toomuchtodo 14 hours ago

1. File a complaint with the state insurance regulator where your insurance is issued in. You can find this regulator at https://content.naic.org/state-insurance-departments

2. File a complaint with the US Dept. of Labor's Employee Benefits Security Administration (EBSA):

The EBSA, a division of the DOL, handles complaints related to employer-provided health insurance. You can:

Call the EBSA: Toll-free at 1-866-444-3272 to speak with a benefits advisor.

Submit a complaint using the EBSA's online form: https://www.askebsa.dol.gov/WebIntake/

The EBSA will investigate the claim and may contact your employer or insurance provider for more information. You may be contacted for additional details or documents. If the EBSA finds that your rights under ERISA (Employee Retirement Income Security Act) were violated, they may take corrective action on your behalf. Keep copies of all documents and correspondence. You can follow up on the status of your complaint by contacting the EBSA at the phone number above.

idontwantthis 17 hours ago

I had a very similar experience with Cigna and a US healthcare provider. The provider was not getting reimbursed from Cigna and Cigna was saying the provider was not accepting the reimbursement.

I got nowhere talking to the provider’s billing department. I finally got it fixed when I called the provider’s corporate office.

I’m not sure if that applies to your situation, but see if you can talk to someone outside of the billing department.

There are also businesses called Healthcare Advocates. You can hire one of those, but I can’t speak to it.