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Cigna International / denial of surgery even with submitted proof from 4 medical professionals

1 Omaha, NE, United States

I have been dealing with back, neck and shoulder pain for years, however, in the past 2-3 years it has gotten progressively worse. My back has gone out a number of times. I have complained about it to my doctor a number of times.

In December 2017 I contacted my primary care doctor and asked for a referral for a surgeon. My surgeon immediately submitted proof that a breast reduction surgery is needed. I also saw a physical therapist throughout the entire month of December 2017. She also submitted proof that the curvature of my spine is being severeley damaged because of the weight. I made an appointment with a spine specialist who completed a physical examination and took x-rays. He found that one of my lumbars is being permanently and horribly damaged because of the weight. All of this information was submitted to CIGNA.

So, my primary care doctor, my surgeon, my physical therapist AND a spine specialist informed CIGNA that I MUST HAVE this surgery. Even after all this medical proof CIGNA still denied it. I'm not sure how many medical professionals need to tell them I need the surgery in order for them to approve it. Ten?! Twenty?! One hundred?!

The interesting part about it is in 1-2 years I may need back and/or spine surgery. CIGNA, I'm sure, would much rather pay $8000 for breast reduction surgery than $169, 000 for spine surgery.

May 4, 2018

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