Coverage Choices
Plan Works Fine, Except . . .
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Schoolteacher and District resident Ryann Galganowicz, 29, has been satisfied with her Cigna PPO medical and prescription drug coverage. It's the mental health coverage that has given her angst.
After going through a divorce last year, Galganowicz had to pay $321 in monthly premiums to temporarily continue coverage under her ex-husband's policy. Last fall, she became eligible for her own work-based coverage, allowing her significant savings. She says she has stayed on the Cigna PPO plan because it "works fine" -- except for talk-therapy reimbursement.
Galganowicz checked with Cigna last fall and found the plan covered 80 percent for out-of-network providers. She even asked how much the plan would pay for a person with her diagnosis in her Zip code: $160 an hour, which was more than her provider's fee. In January, Galganowicz says, Cigna sent her therapist a check for half the $110 fee.
Cigna said the therapist was actually in its network and explained the low reimbursement by saying that Galganowicz did not get a referral from her employee assistance program."It seemed no one at Cigna knew to tell me this before," she says.
After spending more than 15 hours trying to straighten it out, Galganowicz still waits for Cigna to reimburse her for the roughly $4,000 she says she has already paid her provider and doesn't know how much she'll get.
