My husband is 45 years old, he has been diagnosed with anthrosis of the right ankle, an extremely painful and degenerative condition that can only be fix by an ankle replacement surgery.
CIGNA Health Care has denied coverage of the surgery because according to them "There is insuffient information showing benefits in large population, multi-center, controlled clinical studies to support the effectiveness of Total Ankle Replacement for the treatment of any ankle condition".
CIGNA denied the coverage arguing that it is an experimental procedure when in fact, the procedure has been cleared by the FDA 501K approval process, and other insurance companies including Medicare cover it.
The denial has been appeal, but of course CIGNA can take up as much time as they desire, because "there are procedures that need to be follow" while in the mean time my husband's ability to walk decreases by the day, is at the point that the pain medication is no longer helping and as if that was not enough, is at a high risk of having his ankle collapse.
What is very particular about this case, is that CIGNA indirectly recommended another procedure to fix my husband's problem, which is an outdated surgery that according to the orthopedic surgeon (one of the only 10 specialist in the country who is certified to perfom ankle surgery), will cause future complications, which in fact will cause degenerative changes in the joints and the leg.
My husband and I will really appreciate any help you could provide in this matter. Please help us get my husband's procedure approved.
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