cigna appeals – denied after rep said PCP was in-network

So, last year I had cigna and around january I noticed my PCP of 4 years had changed so I called customer support and the representative said that my PCP would be changed back. He said she was in-network and everything was fine. So i continued going to her until April, when the offices informed me that the last 4 visits were not covered by my insurance. After 12 months of communicating with cigna, and having each representative review the original conversations they finally had an appeals board decide on the coverage. And they denied it. I am still waiting on the requested documents from my appeal decision but I am curious if they even acknowledged that I spoke to someone who said my PCP was in-network. In the appeals decision they wrote "this means this EOC does not provide benefits for any services you receive fro an Out-of-network provider" – "in network providers include physicians, hospitals and other health care facilities. Check the provider directory available at www.mycigna.com, or call the number on your ID card to determine if a provider is In-Network" – which I clearly did.

Am i fighting a losing battle here?

submitted by /u/liljobo
[comments]