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Hall of Shame

Obesity, by the very nature of the disease, is a chronic condition. Like virtually all chronic medical conditions, it will worsen if untreated. (Once obesity is established, studies show that the natural course is to gain an additional 1 to 2% of body weight annually.)

Taking a purely "bean counter" approach (no offense intended to accounting or actuarial professionals), treatment of obesity when it complicates medical problems is cost effective. Most insurance companies and (currently) virtually all HMOs refuse to cover obesity management. However, one company in particular seems to have gone out of its way to prevent any treatment.

The undisputed multiple-year winner of the Insurance Company
Hall of Shame Award...

CIGNA INSURANCE COMPANY

CIGNA "won" this award with this initial "accomplishment":

Declaring treatment of obesity as "not medically necessary" for the following person:

A 40-year-old first-time new father who is more than 100 lbs. overweight and has had open heart surgery along with sleep apnea, hypertension, hypercholesterolemia, arthritis, and heart failure.

After Cigna customer relations heard from other insureds about "winning" this award, Cigna said that they would correct the situation.  However, to this day, they continue to refuse to reimburse the insured for treatment.  Their lack of action is probably reflective of their cynicism in dealing with these conditions.

The prejudice against obesity treatment and treatment of eating disorders is well-entrenched in many insurance companies and HMOs. Some of the denials are quite original, stating to their insureds that they don't cover "cosmetic" treatment, conditions that are a "lack of willpower,"  or "personal choices" (these are direct quotes from different patients dealing with  different insurance companies and HMOs).

In another case, Cigna refused payment of medical claims for an employee of an aerospace company unless the intimate details of his personal life (which were purposely encrypted in his medical records so as to be protected) were revealed in a "dictated note".  Cigna could share his medical records with his employer (Cigna could legally do this because of the contract with the employer).  Since the company was "downsizing," the concern was that his medical information would be used to not only cause him personal embarrassment but also be used as a basis to terminate his employment. (And you thought Ken Starr [remember him?] had a unique talent!).

If these were isolated cases, one would not award Cigna such a prestigious award. However, in the emails I receive, it seems that Cigna has a special talent for denying treatment requests that goes well beyond the others. With a recent settlement of a class-action lawsuit in 2004, Cigna agreed to "use standard clinical definitions of medical necessity." However, I have personally seen and been told of more of Cigna's standard denials since the settlement was announced.

You may want to remember this when you are choosing not only your health plan, but your disability, life, or property coverage.

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