I’m 49 yo female in West Virginia, 25428.
I am on my husband’s healthcare plan (Cigna) provided by his employer.
I am legally disabled and was qualified as of May 2013. Though I qualify for Medicare, because I didn’t accept it when I first went on disability, there is now a penalty I would have to pay in order to have it. Because of the penalty I would need to pay, it is less expensive for me to be on my husband’s insurance. That said, I automatically have Medicare Part A (hospitalization only).
I was scheduled for outpatient surgery in October 2021 for a procedure that my insurance policy covered. Before surgery, I got a letter saying that I was approved, as did my doctor. I had already met my out-of-pocket deductible and my out-of-pocket maximum for the year. I had the surgery. In March of this year, I got notification that Cigna denied the $34K charge for the surgery because I qualify for (though do not have) Medicare.
My husband is a contractor for the government and his contract got picked up by a new company in November of 2021. As a result, we have a different insurance policy (though it is also through Cigna) now than I did when I had my surgery in October of 2021. I have spoken to a manager at Cigna and he said there is nothing I can do; that it is in my policy. I asked for a copy of my policy and have been given the run around.
Regardless, if I had known the surgery was not going to be covered, I would not have had the surgery OR I would have prepaid so I could have gotten a 50% discount.
Do I have a case to bring against Cigna? I know it probably depends on what my policy said, but as mentioned, I can’t seem to get a copy of the policy.
If I do have a case, what kind of attorney do I need to seek out?
Thanks in advance. Cross-posted