Patient (North Carolina)

My Patient Rights > Patient (North Carolina)

Patient (North Carolina)

For someone like me on a Cigna plan, I should easily be able to get the exams and medications I need. Unfortunately, that’s not the case. I’m struggling to obtain care, particularly coverage for the medication Duloxetine that I take to manage my anxiety and depression.

I have been taking Duloxetine for chronic pain, anxiety, and depression for the last year. I started at 20mg, and after a while my doctor doubled my dose to 40mg. I’ve been taking 40mg for almost two months and it works extremely well. I had 9 months of 20 mg pills, so my doctor told me to start taking two and he’ll give me a prescription for 40mg should it continue to work well. Now, we know it works but Cigna is denying coverage of Duloxetine at 40mg.

Cigna has undermined my doctor and is forcing me to take the 30mg pill which is ineffective, and I can’t double my dosage to 60mg because I will experience adverse side effects. Cigna offered alternative medications that they will cover, but I have colitis and starting new medications means I have to start from the beginning with dosage. I don’t have the time or energy to fail on alternative medications when my doctor and I both already know that 40mg of Duloxetine is effective.

Even with faxed paperwork submitted by my doctor verifying my need for Duloxetine at 40mg, Cigna continues to deny my prescription. Now they are insisting that they didn’t receive paperwork from my doctor, and that it takes up to five business days for anything to show up. It’s been much longer than five days and if it ever gets in their system, it then has to go through their 90-day approval process.

All this waiting is exacerbating my depression, chronic pain, anxiety, and stress.

The hurdles I’ve had to go through to access Duloxetine are only the beginning. So far, every single claim that I have submitted for services prescribed by my doctor has been denied. I have appealed every denial, but it takes an unreasonable amount of time for Cigna to make a follow up decision. I have spent countless hours on the phone with them trying to get my treatments covered, being on hold, and at times being hung up on.

The first denial was a mammogram. Every week, a bus parks in the lot of the local community health clinic and they offer mammograms to patients in my area. Cigna refused to cover my mammogram and sent me a bill of nearly $1,000. It took two months for Cigna to finally cover my mammogram after I appealed.

Cigna also refused to pay an $800 bill that I received after getting X-rays of my shoulder and hip. I appealed, but my credit is taking a hit during the 90 days it will take to receive a decision.

Unlike other Cigna policies, my ACA Cigna policy does not cover my local physical therapy provider. I badly need physical therapy, but I would have to appeal and wait 90 days to qualify under a special New Access Points (NAP) program for rural patients. It’s unreasonable to make me wait up to three months before I can start physical therapy.

This is an unbelievable jungle that I can’t find my way through to get the treatments and medicines I need to stay well and functional. There is a clear pattern of negligence and incompetence from Cigna that must be solved at a structural level. If I am experiencing this much trouble from them, I can’t imagine how many more people are going through the same. Patients deserve timely, affordable, and quality care – not to jump through extreme hurdles that cause undue stress and suffering.

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