Claiming that Big Brother has taken over the health-insurance industry, a woman who has waited nine weeks for approval of hernia surgery is standing her ground against CIGNA HealthCare by refusing to fax the company semi-nude photos of herself.
Each day Long Island resident Robin Boerner’s ventral hernia goes untreated, the chances of it becoming incarcerated, requiring immediate surgery and causing permanent damage, increases.
“I’ve been asking for surgery for weeks and keep hitting one road block after another,” Boerner told WorldNetDaily.
Boerner says she injured herself in February on the job as a millworks specialist at a Lowe’s Companies store in Medford, New York.
“I moved a box and felt it pop,” said Boerner who suffered the same injury on the job back in October. Lowe’s worker’s compensation carrier, Specialty Risk Services, Inc., summarily denied Boerner’s claim, calling it a pre-existing condition and asserting it wasn’t an on-the-job injury. Boerner hired an attorney to appeal SRS’ denial. In the meantime, she filed a claim through Lowe’s self-insurer, CIGNA HealthCare. That is where she hit what she considers to be a more unusual roadblock.
Surgery to treat the current hernia marks the third procedure Boerner would be having along the same scar line. Her primary-care physician blames the reoccurrence of the injury on a build-up of scar tissue in the area and recommends a plastic surgeon be a part of the operation this time to remove the scar tissue, thereby enabling the area to heal properly once and for all. Boerner subsequently got the same opinion from a general surgeon and three plastic surgeons, one of whom, Robert Jacobs, filed a surgical predetermination of benefits request with CIGNA indicating the medical necessity of the operation. Not satisfied with Boerner’s physician opinions, CIGNA requested that the photographs taken for the benefit of the plastic surgeon be provided.
“They wanted me to fax pictures of me in my bra and panties, with the panties pulled down to my crotch, front and side views,” complained Boerner. “I’ve never heard of an insurance company wanting faxed photos to determine a claim. Have we gotten to the point where CAT scans and MRIs are replaced by Polaroids in the insurance companies’ greed to hold down costs?”
When Boerner resisted, explaining she felt uncomfortable about faxing such private images of herself, she says she was told by the CIGNA representative Lisa Abernathy, “We will not consider this claim favorably without these photos.” Abernathy then, according to Boerner, offered to have “someone standing next to the machine to take the photos off” if that would make her feel better about faxing them. Boerner says a liaison to the president of CIGNA, Janice Morales, also told her the claim would not be approved unless she submit the pictures adding, “We have women faxing pictures of their breasts all the time.”
In response to calls, Abernathy stated she could not discuss Boerner’s case or anything else, and Morales likewise referred WND to the public relations department and declined to comment on her communication with Boerner. When asked about CIGNA’s requiring photographs, and apparently relying on them over the opinions of physicians, the corporate communications director indicated he would need to check with medical directors before responding.
An insurance coordinator in Dr. Jacobs’ office told WND that she has worked with insurance companies, handling predeterminations for four to five years and that “99 percent of the companies want pictures, which we provide.” The woman reportedly told Boerner that she was the first patient to object to providing the photographs.
“That just tells me what a sad state of affairs America is in, that we just comply willingly to send half-nude pictures of ourselves out to insurance companies,” said Boerner, “I consider these pictures to be private.”
Failing to impress CIGNA of her need for privacy, Boerner put several calls into the office of her New York senator, Hillary Clinton. After initially being told the senator would look into it, Boerner has heard nothing more.
Boerner next worked through the ranks of supervisors at Lowe’s all the way to the chief operating officer, Larry Stone. Boerner claims she was told by Ken Zworka, the regional human resources manager and his supervisor, Human Resources Director Bernie Smith, “We’re prepared to give you the surgery as soon as we get the pictures.”
Zworka offered “no comment” when asked to confirm the statement, and Smith told WorldNetDaily, “At this time, I can’t recall.”
“To me, it’s like Big Brother is here. They want semi-nude pictures or they’ll withhold insurance from you. … It’s an outright form of intimidation,” Boerner told WND.
Tawn Earnest, Lowe’s public relations manager maintains, “It’s standard practice to require photos throughout the insurance industry. … It’s what the industry does to independently verify a claim.”
Joe Luchok, communications manager for the Health Insurance Association of America, a trade organization for private health insurers, explains: “Photos can be used for some procedures – most commonly facial or breast reduction procedures. Why this particular company wants this particular picture, I can’t say. … It sounds like a very unusual situation to me. … Why not just accept a picture of the area in question?”
Boerner had offered to do just that for CIGNA. Despite the offer, the company subsequently sent notice to her that it was declining to cover the surgery for the hernia “precipitated by lifting in the course of Robyn (sic) Boerner’s work activities.”
CIGNA effectively sent Boerner back down the road of worker’s compensation, where she has prevailed. Relying on the report of an independent doctor chosen by Lowe’s who found that the hernia (1) was caused at work, (2) was medically necessary, and (3) needed to be operated on soon in order to avoid permanent damage, a New York judge ruled yesterday in favor of Boerner’s appeal of SRS’ denial.
“It took the judge all of about two minutes to approve the surgery,” Boerner laughs. Nine weeks after her injury, Boerner now has the green light to schedule the surgery to be covered by her employer. That is, unless Lowe’s appeals the judge’s ruling.
“Every morning we have a pep rally where the managers and assistant managers call everyone up front and give us rah-rah speeches and then they get everyone to do the Lowe’s cheer,” Boerner describes. “I believe they said this morning that they made $1.7 million in revenues last weekend in my store alone. My surgery will cost less than one hour of sales. … Yet, they just kept objecting to it up to the very last minute. They have no morals. … Lowe’s doesn’t care about employees, despite their propaganda.”