Insurance company changes position, will now pay claim – The Boston Globe

But for more than a year, Cigna, one of the nation’s largest insurers, refused to pay, said Cregg, who was 66 years old at the time of the surgery, should have been. in Medicare Part B. Instead of risking debt damage, Cregg pays the bills. from his doctors.

Cregg’s plight was revealed in the Globe’s The Good News column on Monday. The column focused on the lack of clear communication about Cregg’s responsibility to go to Medicare.

The column received a lot of attention, with nearly 300 readers posting comments online, which were published under the headline, “Don’t make the same Medicare mistake that this couple. They are very expensive.”

On Tuesday, one day after the column appeared, Cregg got a call from Cigna saying it would pay for his arthroscopic surgery after it was over, Cregg said.

Cregg said Cigna told him it would pay his doctors and they would reimburse him.

“I’m very pleased to have found a reasonable resolution to this dispute,” Cregg said in an interview after the call. “Cigna was wrong from the start. I tried several ways to resolve it but Cigna ignored me.

The difficulty took its toll on Cregg. In one letter to Cigna, he wrote, “This situation damages me every day and causes me and my family great concern. My being in this situation is not right, it is not right, it is not legal. I really appreciate Cigna doing the right thing, paying off the outstanding debt, and letting me get on with my life.

Frustrated, Cregg turned last month to the Globe for help. Cigna, however, declined to directly answer detailed questions from the Globe, which was sent along with copies of documents prepared by Cregg before publication.

One of those documents was a letter from Cigna to Cregg saying “after reviewing your medical information and your health plan, we approve (the surgery).”

Many readers posted comments to the column expressing sympathy for Cregg and uncertainty about health insurance.

“(Cregg) had written records from Cigna authorizing the procedure. How can Cigna say ‘we made a mistake’ and not pay?” asked one reader.

“Bingo,” replied another reader. “If there’s any credit, Cigna is doing what it does best: Reinventing.”

“I think it’s a shame because Medicare (is) complicated and difficult to understand,” said another reader.

This is what happened:

Cregg turns 65 in 2020, but hasn’t signed up for Part B, which covers physician appointments and outpatient care. Everyone must sign up at 65 (or face penalties later), but there is an exception that applies to Cregg: he was still under his wife’s Cigna insurance plan at work.

But about a year later, his wife, Bethann, was laid off from his job at an out-of-state technology company. Bethann’s former employer offered the couple coverage under a law called COBRA, which requires most employers to continue to offer group insurance to terminated employees for the less than 18 months.

With Bethann too young to go on Medicare, the Creggs opted for COBRA, ensuring they would receive all the benefits and rights of active duty workers. What the Creggs didn’t know is that under Medicare rules, being in a COBRA plan is not the same as being an active employee.

In fact, Medicare allows eligibility for enrollment at age 65 and older only for those who have employer-sponsored insurance and are employed. still, but not for those who have employer-sponsored insurance but are not employed, such as those covered by COBRA. .

Cregg said someone should have told him outright not to go on COBRA and to sign up for Medicare Part B. Instead, he said he was led to believe there would be no change in his situation at under COBRA.

The seven-page, one-page letter Creggs received to notify them of their COBRA rights says terminated employees and their COBRA dependents “will have the same rights under the (Cigna) plan as like other participants” in the plan.

Cigna did not respond to questions Wednesday but released this statement: “While we cannot speak to any customer’s case, we encourage customers to discuss their insurance policies, reach to their insurance company or COBRA manager, and work with their doctor to verify coverage and any limitations before scheduled care.”

Anyone who needs help managing Medicare can get free help from Bright program through their senior center.


Got a problem? Submit your purchase case to sean.murphy@globe.com. Follow him on Twitter @spmurphyboston.

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