By Consumers For Quality Care, on August 5, 2019
In 2017, Lancaster resident Carolyn Daigle was helping an elderly relative get out of the shower when she fell. After the accident, Daigle went to see her primary care physician, thinking that she had hyperextended her back, according to the Union Leader.
At her doctor’s direction, Daigle took over the counter pain medication and started doing therapeutic yoga. Her pain continued to worsen. At times, it was so bad that she would crawl on her hands and knees. In early 2018, she went back to see her doctor, John Ford. Ford suggested that Daigle have an MRI and sent a prior authorization request to her insurer, EviCORE, a subsidiary of Cigna.
Days later, Cigna denied the scan, arguing that it was “not medically necessary” in Daigle’s case. Ford called the insurer to appeal and had a peer-to-peer discussion of Daigle’s case with an EviCORE representative. But, again, the MRI was denied. A few months later, Ford tried a third time and was denied again. Finally, after Ford’s second peer-to-peer conversation with insurers, Ford was able to get the MRI approved.
In late March 2018, Daigle received the MRI. The scan showed what turned out to be a non-cancerous tumor, encompassing three vertebras of Daigle’s spine near her spinal cord. Daigle had surgery to remove the tumor, but it had already caused “irreversible damage” which left her paralyzed below her ribcage.
Now, Daigle and her husband are suing Cigna and EviCORE for delaying the MRI with denials.
According to the Daigles’ lawsuit, which was filed by attorney Nick Abramson, Carolyn Daigle was an active wife and mother who in the latter part of 2017 suffered a fall while helping an elderly relative get out of the shower.
Abramson said Daigle’s “bright future has been sacrificed to avoid paying for a $2,000 MRI.” Daigle “should be able to live the life she worked so hard to obtain,” he said in a statement, but, “instead, she will spend the rest of her life in a wheelchair.”
The lawsuit alleges that the insurers did not do their due diligence, instead rubber-stamping patient denials out of greed. They also say that Cigna made its determinations based on criteria it did not share with Daigle or Ford.
The lawsuit seeks compensation for Carolyn Daigle’s economic losses, permanent impairment and disfigurement, past and future loss of enjoyment of life, future physical pain and suffering, and emotional distress.
Cigna has said that it is not able to comment on pending cases.