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Great-West/Cigna Pay Less Than 1/3 of My Medical Bills

Loveeta
Weaverville, NC
Heathcare Status: Employer Insured

In a nutshell...through my employment I thought I had good coverage through my health insurance provided by my employer, with Great-West. I had a colonoscopy (family history of colon cancer) at age 52, discovery of a mass, quick surgery that went completely right! 5 days in hospital, no complications at all.

In a few weeks the bills, claim information started rolling in. I knew I'd take a larger than normal hit because out-of-network pays 1/2 of costs. I'd never had any luck finding an in-network provider in my area. The closest in-network GI provider information provided by Great-West was over an hour away, and when I called the office, it was in fact a psychiatrist's practice and not a GI doctor at all.

But, alas, Great-West is paying just under one-third of my total costs, using "average contracted rate" as the reason. Many unanswered questions that I'm still working on, but health insurance shouldn't be this complicated. These companies should have forms that are easier to decipher, and live up to what they promise in their glossy promotional literature that has you believing they're "there for you," practically best friends.

Right now I feel like I'm in the movie "Sicko," though I know my problems are small compared to others. I am continuing to make my insurer explain, and pushing for accountability with the help of a consumer group; and counting my blessings for not having a bad outcome on my colon surgery.

Learning my lessons the hard way, Loveeta

Submitted on July 2, 2008 - 11:15am.
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I work for an insurance

Submitted by Anonymous (not verified) on July 16, 2008 - 8:17pm.

I work for an insurance company, and in fact was an appeals processor until recently. If I were you I would file an appeal for in network benefits sighting "network adequacy"

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Absolutely file an appeal.

Submitted by Anonymous (not verified) on July 18, 2008 - 6:24pm.

Absolutely file an appeal. Employer insured employees and/or dependents need to remember that it's your EMPLOYER who makes the choices for health insurance. And if you don't have a local provider, you have the right to ask your employer to contact the provider directly to ask that they become a contracted provider with your employer's choice of insurance carrier. You can also personally request directly to the providers in your local area to contract with the insurer your company has selected.

I really stress that the American public get more involved with their insurance coverage: you almost MUST research state and federal legislation/mandates to find out your rights.

As someone who worked for a large insurance carrier for almost 22 years, I can't stress enough accountability on those people who are insured. It's not always the insurers' fault, as most people tend to finger-point. Insurers DO have to comply with the law - so check into that avenue as well.

As I blab on, I must also remind anyone reading this blog that there is a vast difference between medically-necessary (as dictated by law is some jurisdictions) and elected procedures.

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