Guaranteed Healthcare

My 14 year old daughter tore her ACL during the first soccer game of her season. After surgery, she went for physical therapy for 6 weeks and then a follow up visit with the surgeon. Surgeon writes detailed prescription with multiple diagnosis codes for 4 more weeks PT. CIGNA denies additional therapy stating: her rehabilitation goals have been met. Surgeon & physical thertapist stated "NO" they have not been met,but CIGNA stuck to their guns even on appeal and denies the extra 4 weeks, based on an internal insurance doctor's determination. Appeal denial letter contains language that suggests CIGNA did not want to pay for any medical treatment that is meant to enhance a sports career whether current or potentially future. When I worked as a claims examiner for prudential the mentality in training was to deny claims for any error. I was setting records for completing claims because many of these "errors" could be resolved with a quick simple phone call, and I was making those calls. When management tried to stop me from doing this I pointed out the cost of denying a claim only to have it resubmitted, versus the cost of settling it right away. They wouldn't state the obvious, which is when they deny a claim they are hoping the insured does NOT pursue or re-submit. They afterward put me in a special unit to deal with the most complicated claims, claims of course that could not be settled with a simple phone call. At the time they had the best record out of all for settling in a timely manner---so if this is the mentality of the best company out there imagine what the rest of them are doing.