Anyone have Cigna or First Health insurance?

Discussion in 'Fibromyalgia Main Forum' started by Mar19, Oct 27, 2005.

  1. Mar19

    Mar19 New Member

    We've been convered for years by Aetna healthcare. To be honest, I've not been thrilled with them.

    DH's employer is dropping Aetna as an option and we now have to chose between Cigna and First Health.

    The Cigna is an HMO with a fairly high employee pay-in. I've not heard many good things about Cigna, but I'm willing to be persuaded to try them.

    With First Health we'd have a choice of a PPO or EPN (Exclusive Provider Network) -- whatever the choice we'd use caremark for Rx coverage.

    Right now we're leaning toward the FirstHealth EPN. It costs more in employee pay-in, but would be made up in no time with Rx co-pays and doc visits. The only thing that holds me back with the EPN is that you *must* stay withing network.

    Staying in network shouldn't be hard, we've had to do that with Aetna anyhow -- and all the docs dh and I both see are in network.

    If anyone uses any of these companies or plans, could you share some of your experiences with me before we have to enroll??

    Thanks.

    Love & blessings
    Mar
  2. JPach007

    JPach007 New Member

    My husband works for a large company and every year they do extensive research to find the best one...
    We jsut signed up with Cigna again for 2006. Everything is going up however..Dr visits were $10 last year, $15 this year and going up to $20 in 2006. Generic meds are going up also. Coverage is very good though.
  3. Mar19

    Mar19 New Member

    jpach, sounds like you have a different Cigna plan than the one we're being offered. Our co-pays are higher and the Rx costs are higher still.

    Have you ever had any problem with Cigna paying a claim? Do you have an HMO (that's what we'd get) or a 80/20 policy?

    The only thing I really liked about Cigna was that they had no limit to the maximum lifetime benefits -- the others were all set at $2million (which I hope never to meet).

    My niece had Cigna 80/20 coverage several years ago -- she has lupus and had many visits. There are a lot of claims that they rejected and never paid.

    Anyone have any experience with First Health??? Or the mail order pharmacy? It looks like the drugs we take regularly on *all* plans would fall under the mail order pharmacy -- I've never used that option.

    Thanks in advance
    Mar
  4. Mar19

    Mar19 New Member

    DUH!!

    I just noticed that you are expecting!! Congratulations!!
    My youngest daughter had her first baby and my first grandchild on 9/29 -- her pic is in my profile. Love your sonogram! Do you know the gender yet??
  5. ilovecats94

    ilovecats94 New Member

    Mar,
    We have no choice this year but United Healthcare which we have had for 2 years. We are very happy with it, but our family doc won't take it anymore.

    We used to could get Cigna HMO, but the PPO is preferred to the HMO. My eye doc won't take Cigna and the Health Care Plus where I go to get my mammograms won't take Cigna anymore, so I'm glad we are still able to get United Healthcare. We don't need to get referrals and our meds are $10/$20/$35, which isn't bad.

    We will have to find new family docs and going to get on that as soon as possible. Have been with the other family docs for 25 years, so this is a major change for us. I just hope I can find someone who believes in FMS.

    Odd, but we just got our healthcare info in the mail today.

    I'd go with First Health if I was you and yet I don't know anything about it.

    Check and see if they take your doctors, what kind of deductibles they have, etc. If it sounds good then go with it.

    I hate having to make these decisions. There should be healthcare for all and it be fair and all docs should have to take it too. But that is dreaming, I guess...

    You have to go with the insurance company you feel good about. Cigna isn't well taken here for some reason. I'm in Virginia...

    Hugs,
    Faye
  6. Mar19

    Mar19 New Member

    One of the problems w/the Cigna HMO we are offered is that almost NONE of our docs accept it! Their RX prices are lots higher also.

    The FirstHealth has all our docs in network, doc visits are cheaper and the RX prices are cheaper also. I just don't know how they are to deal with. Sounds like the best bet so far, but it would be really good if I found someone who had experience with them.

    My monthly appointmet, thankfully, is scheduled before the enrollment deadline -- I'm going to talk to the girls in the office and see if they can give me any insights about the two companies.

    Yeah, I hate having to make these decisions also. I probably would have ditched Aetna long ago, but I always figured that even though they were miserable to deal with, I at least knew most of their tricks! :^)

    Health insurance companies are a real racket, don't you think? What a hassle.

    DH attended a meeting about the new changes this morning at work. The HR guy who was running it had absolutely NO idea of what was what. He didn't know the differences between any of the plans -- had no idea what a drug formulary was -- and the list goes on and on and on... The employees were not happy campers... Oh well, worst thing that can happen if we're not satisfied is we're stuck for a year. But it would be a veeerrrrrryyyyyy long year!

    Thanks for your input.

    Mar
  7. Mar19

    Mar19 New Member

    Awwwwwwwwww! I *love* little boys!! How wonderful.

    You're right, she does have LOTS of hair -- it looks like it's going to be curly as well!

    I love being a gramma! Unfortunately my daughter lives about 1,000 miles away so there won't be too many chances to visit. I was really thankful to be able to get there and meet the little angel when she was only 2 days old. DH and I stayed for about a week.

    I'm guessing you're going to be one terrific Mommy!! Can't wait to see the little munchkin's picture when he finally makes his appearance!

    Love and blessings
    Mar

  8. simka

    simka New Member

    We only have personal experience with PPOs, vs HMOs. Doctors prefer the PPOs even if they are in the HMO network it seems to me. HMOs may be good for healthy people that need only routine medical care whose doctor is in the network, and stays in the network.

    I'm very glad we're with PPO vs HMO, I think it has made a big difference given the health issues I've faced.

    When I first became quite sick and had to see a specialist, we had First Health PPO, very good to deal with, no problems at all with the tests or visits. Then Aetna PPO, not good at all. When I tried to get information from them about tests they refused to pay for I didn't get it, and didn't have the energy to pursue.

    Now United Healthcare, doctors seem to like it better than Aetna. I don't have enought experience to judge, but it isn't as good as the FH coverage I had.

    Personally, if I had the chance for FH PPO, I would take it even at a greater cost.

    These are very tough decisions for people with health issues and budgets. Good luck, let us know how things turn out.

    Simka




  9. abbylee

    abbylee New Member

    Hi Mar - We have BCBS, but use Caremark for prescriptions. They pay for 80% of my Xyrem but I had to get special permission, otherwise it was 60% because it was an out-of-network pharmacy. (PPO) So far we've had no problems.

    abbylee
  10. Mar19

    Mar19 New Member

    Very helpful info indeed!! Thanks.

    First Health now offers an EPN (exclusive provider network) which seems to have even better coverage than the PPO -- and all of mine and dh's docs are in the network. It costs more as far as employee contributions are concerned, but the savings on doc visits and Rx's will make up for that in a month or two. I have to go at least once a month, sometimes twice.

    Did you have any experience with FH's mail order pharmacy? It's provided thru a company called "caremark". Their co-pays are a lot less than what we've been paying thru Aetna. DH asked the HR rep at work how to access their drug formulary so we could check and see what was on their "preferred" list. I've never dealt with mail order, but I know others have, so it must be ok. Right???

    I've just checked thru the Cigna provider list and they only cover ONE of my 4 or 5 docs -- not good at all.

    I think I'll really be glad to get rid of Aetna -- they can drive you crazy trying to deal with them! Oh! The stories I could tell.... LOL

    Thanks again.

    Mar
  11. Mar19

    Mar19 New Member

    Thanks to you also.

    How difficult was it to get caremark to cover the xyrem? I've tried to get Aetna to cover meds that they didn't "approve of" -- basically all I accomplished on that front was elevated blood pressure from the hassle of dealing with the "idiots". :^) It makes me so angry when someone who has never laid their eyes on you is deciding what medical care is best for you. Ack!!

    I'm glad I started this thread -- all of you are helping me make a more informed decision. I *love* this board!!!!

    Mar
  12. abbylee

    abbylee New Member

    Companies pick what their insurance policies do and don't cover. These same companies also want happy employees.

    Tell him to go to HR and ask them to make an exception in this case. Usually, they comply.

    My problem came when my dose of Xyrem caused me to have to buy it every 22 days rather than 30 days. (It's liquid and they can't send a partial bottle.) So I had to get a letter from the doctor explaining things yet they still threw out my claims because it hadn't been 30 days.

    This went on for several months. Finally, a case worker got involved and I send my claims directly to her.(My other claims go to caremark.)

    The only other thing I've noticed is that they pay my husband's 1 drug claim in a week or so, but it takes them several weeks to pay mine. I figure it's because there are 10 per month and the money paid out is much more.

    abbylee
  13. Mar19

    Mar19 New Member

    The Rx plan we're being offered with caremark is set up on a co-pay basis. Our share would be from $10 to $50 depending on the drug and whether it's a one or three month supply. It's considerably cheaper than what we're paying now w/Aetna, and also cheaper than the set-up with Cigna -- their co-pay for a three-month, non-formulary is $120 compared to $50 with cm.

    DH brought home lots written materials from HR today regarding both plans they're offering. The person giving the sales pitch yesterday knew *nothing*!! I gave dh 5 or 6 questions to ask and the HR rep giving the pitch drew a blank on all of them. duh!

    Later on today, when my brain actually wakes up ::grin::, I'm going to check online for more info on caremark -- the HR gave him a password to get into it so we can check things out and see if they cover all the Rx's I'm currently on, and a couple that Aetna refused to cover.

    He's not the type to go to HR and complain... he hates that sort of thing. Besides, I've been the one dealing with insurance companies for all these years trying to get them to cover what I need with this dd. I'm thinking Aetna will be just as happy to get rid of me as I will be to get rid of them.

    Insurance companies certainly have made getting the medical help we need next to impossible, don't you think?

    Thanks again.
    Mar

  14. abbylee

    abbylee New Member

    Your husband's <b> company </b> is the villian here. Insurance companies offer several different plans to employers. The employers choose the plan or plans for their employees.

    If you have a special condition that is not covered in the plan that your employer picks, HR can contact the insurance company and tell them that in your case they will cover the claim.

    The insurance company will do whatever your employer is willing to pay for.

    I spent almost a year calling BCBS/Caremark because even though my doctor had written them a letter telling them that I received my Xyrem every 22 days instead of every 30 days, they kept throwing out the Xyrem saying I was filling it too soon.

    Finally, I was assigned to a special case worker and SHE tried to run the claims through the system. They STILL threw them out, so now I fax the claims directly to her and she overrides the system so that I'm covered.

    And since BCBS had given me such a hard time for so long, AND because Xyrem can only be purchased from 1 pharmacy in this country, they agreed to cover Xyrem just like they would if I got it from an in-network pharmacy.

    The point is, whatever plan you choose, if your husband's company wants happy employees (and they usually do), they can override anything that is not covered on your policy.

    I don't believe for a minute that the company's precident/CEO or whatever would let an insurance company deny a claim for his family whether or not it's really 'covered.' He'd be on the phone in a minute to the insurance company and he'd make sure it was covered.


    abbylee
  15. chp1298

    chp1298 New Member

    I have had Cigna for 2 yrs and will sign up again. They have been wonderful to us,never denied anything.
  16. JPach007

    JPach007 New Member

    Hi Mar,
    We have Cigna PPO. I think the company that my husband works for gets an additional discount or something because they are a large, multi location, International company and they use Cigna company wide, so that may expain why your rates may be higher also a PPO.
    I've never had a problem with Cigna not paying something, except they wouldnt cover my breast reduction I wanted to do. They said it was in the "no exceptions list." I do my own allergy shots at home now, and the allergy test and shots are all paid 100%. I cant complain!
  17. Mar19

    Mar19 New Member

    I did miss your point. Can I plead senility? LOL

    It's a very good point also. I wish I had thought of that when I was getting so much grief from Aetna. I'll certainly keep your thoughts in mind whatever plan we choose for the upcoming year.

    Bravo!!

    Mar
  18. Bailey-smom

    Bailey-smom New Member

    to your favorite children’s song or something so it does not sound like I am “bashing” because that is not the intent in ANYTHING I type so please do not take any part out of context.

    I am part of a PPO yet I can go to any Dr I choose – I was under the assumption you could only go to certain Drs under an HMO. Is this not the case? If that is not so I would choose the plan which matches the Drs that I have found that I like and that treat me because it is so difficult to find a good one.

    I noticed in another post that a lot of Drs would not take Cigna – it could mean they are difficult to work with as well. Bad sign – especially if they will not sign up to work with them. Maybe call your drs office and ask them – I’m sure they will tell you what the deal is and who they see as being a better company.

    Wow – I can’t believe you are talking such low $$$ for prescriptions. I pay full price – my plan only covers $500/yr and I take $600/mo now. I am stuck where I am because I am uninsurable and can not go on another plan. I’m glad you get such a good break!!!

    Here is a partial explanation on why insurance companies may do some of the things they do (from an agent point of view). The companies pay for our dr visits and meds with the premiums that they bring in.

    I know it seems like we pay a lot but if you are like me, you have more bills than you pay in premium. My agency looses over $200,000 year in health costs alone each year and I live in a town of 900 people.

    As far as covering certain drugs – my company does not exclude drugs – but I am sure other companies are exclude higher cost drugs in the cases where there are lower cost drugs that are shown to do the same thing (on paper, but we know the difference). Especially when the client only pays $25 or $50 no matter if the drug is $70 or $150.

    I am not saying it is necessarily right but they do tell you before the policy is written – in other words, you are not being taken for a ride.

    I do have another question for all of you. If you get your insurance through work – what happens in your states when neither spouse is working. Are you going to have to find a private plan? Will you have the same choices that you face now? I just wondered how it worked in other states because we are all uninsurable now with so many problems with our health.

    I wish I could be more help!

    Kelly
  19. abbylee

    abbylee New Member

    Yes, I'll forgive you this time, but watch out! When I started having problems figuring out what I was reading everything else started going downhill!!

    Glad you finally got the message, though. Someone told me about that a few years ago, and when I see folks trying to get something approved with insurance, I try to tell them how the system works. Most of the time the employer would rather approve an exception than have an unhappy employee.

    abbylee
  20. Mar19

    Mar19 New Member

    My brain's been fried for years!! If only this were the *beginning*... LOL

    At any rate, I'm glad I *finally* got your message to register in my brain (or lack there of).

    Other than the Xyrem, have you had any problems with caremark? Do they seem to cover most everything you need, Rx-wise?

    Over the last 4 or 5 years, Aetna has gotten to be real stinkers -- actually 'idiots' would be more accurate. It can be very stressful dealing with some of their antics.

    My last adventure with them? They approved, with absolutely no problem Botox for muscle injections. Know what they gave both the doctor and I tons of trouble on? They claimed that "administering" the drug was considered "investigational and/or experimental". Sounds good, unless you consider that it was administered via injection!!

    My doc tried for months to get them to pay the bill and they refused. He finally billed me, when I read the reason for the denial, I asked Aetna to explain (because "dumb little ole me" didn't get all this technical talk) how and why they considered a doctor giving a patient an injection would fall under the category of investigational and/or experimental.

    The only answer I got from them after that was notification that the bill had been paid and I no longer had to worry about it. Like I said, IDIOTS!

    We're pretty sure we'll be going with the FirstHealth/caremark package -- I'm still waiting for DH's HR person to give us info on caremark... they don't seem to have that info on hand for some reason or the other... Oh well.

    Thanks again for the heads up. I'm going to keep your tip onhand in my med file for any future problems.

    Mar