My latest Facebook post on Cigna’s page:
This is my three year old son, Eli. Eli has apraxia, which is a severe communication disorder. It is neurological–his brain knows what he wants to say, but there is a disconnect and he cannot make his speech organs say it. The only treatment is intensive 1:1 speech therapy. It is not a developmental delay, and he is not just a “late talker.” His brain does not work the way ours do.
A year ago, Eli was non-verbal. Today, he speaks in some sentences and short phrases and is slowly becoming more intelligible. He works hard but has a long road ahead. We have paid for his services out of pocket because Cigna claims they are not covered. In fact, they are.
Last year, we successfully appealed Cigna’s denial of our claims. While Cigna denied them as not medically necessary, or not covered as short-term rehabilitative, the external reviewer strongly agreed with me that they are medically necessary and covered under my plan.
Despite this binding decision, Cigna has continued to deny coverage for Eli’s speech therapy. So, we have continued to pay ourselves. Recently I filed another identical appeal, which Cigna denied for the SAME REASONS as last time, which is egregious, offensive and in direct conflict with what the external review said. On top of that, I was provided with NO information about how to appeal externally again.
I am perplexed, angry and frustrated that Cigna continues to do this to us and deny my son coverage of the services he so desperately needs. When I called yesterday and inquired further, I was given the party line that speech therapy is not covered under my plan, when it has been made clear to all parties that in our situation it is. I was told my only remedy was to call the Department of Labor. I spoke to the Department of Labor, and it is clear that my rights are being violated. I will not stop fighting for my son. And I will not quietly go away. Cigna should be ashamed.