It Could Happen to Anyone

September 16, 2009

Mr. H. Edward Hanway
CEO
CIGNA

Dear Mr. Hanway:

I write to you as a CIGNA customer, and as one of the millions of Americans who have been neglected by their health insurance company. I faithfully paid my insurance premiums for almost six years because I believed CIGNA would be there for me…until you were not.

In 2005, I was diagnosed with a brain tumor—then in 2007, a second one. After a battery of tests, three doctors from three leading health care systems in the metro Atlanta area agreed that my only chance for a cure was to see a specialist at Cleveland Clinic or Washington University’s Center for Advanced Medicine. I have their four letters.

Yet for two whole years, CIGNA has refused me the care I need. You have answered my repeated appeals for testing and treatment with generic denial letters claiming the necessary treatment was first “medically unnecessary,” and then, “out of network.” What is most appalling is that the inaccuracies in your denial letters clearly indicate that the CIGNA National Appeal Unit never even read my carefully prepared appeals.

Meanwhile, my symptoms worsen. Debilitating electric-shock-type pain racks my body and shoots through my head. I have sudden, painful seizures, sometimes knocking me to the ground. The seizure medications barely help, while their side effects ravage my body.

As the CEO of CIGNA, Mr. Hanway, I demand that you justify the decision of your National Appeals Unit. I have proven that my treatment is medically necessary. The doctors CIGNA referred me to agree they cannot provide the required treatment in-network. They implore you to allow me to be tested and treated at an out-of-network facility.

Mr. Hanway, as a human being, how can you allow another’s life to erode further into pain and permanent disability thanks to your employees’ decisions?

My story, as awful as it is, is all too common. I know there are millions of other Americans with stories like mine. I know that many of them are worse off than me. I read about them in the paper. I talk to them at support groups.

When a man in my brain tumor support group with a deadly form of brain cancer asked for health care assistance, he learned there was a two-year waiting list. I wept as he told our support group that he did not expect to live long enough to receive the assistance he desperately needed. These stories are symptoms of a larger problem—a broken health care system.

As you might imagine from someone in my situation, I have been following the health care debate quite closely. So I was surprised when I saw your press release last week where you wrote, “…changes to the system are long overdue.” I could not agree with you more, Mr. Hanway. But let me ask you this: Why must you wait for a vote from Congress, or the stroke of President Obama’s pen, to do right by your customers?

In your press release, you voiced your support for solutions that, “guarantee coverage for pre-existing conditions, exclude the calculation of premiums based on health status or gender and expand access in a cost-effective manner while preserving individual choice.” I applaud your words, Mr. Hanway, but I need to see deeds—and not just for me, but for all of your customers.

Mr. Hanway, you have the power to enact these changes now and set the pace for your entire industry. You have the power and the responsibility to provide me and other CIGNA insureds with what we have paid for: quality, affordable healthcare—without strings and without loopholes. My six years of dutifully paying you premiums—now $753.65 per month—should buy no less.

I anxiously await your reply.

Sincerely,

Dawn S. Smith

cc: The Honorable John Lewis