Sunday, November 18th, 2018

Professor and partner asked to pay Cigna for cancer treatments: Trustees clarify disputed benefits

Posted on November 09, 2012 in News
By Nathan Mooney

Professor of New England Studies Ardis Cameron and her partner, Nancy MacKay, didn’t have a spare hundred grand kicking around and certainly not for something that their health insurance had covered without issue for the past two decades. After a few months of frustration and confusion, though, a decision made this week by the board of trustees ensures their money will remain their own.

The couple was understandably shocked a month ago when they got a letter from Cigna, the company that administers the UMaine faculty health insurance, saying they owed over $90,000 for treatment they thought was paid for. That first letter, according to Cameron, signaled the beginning of Cigna’s attempts to recover funds paid for the treatment of MacKay’s stage 4 battle with cancer. The letters continued to come. Cigna even called the Maine Cancer Center and demanded the return of their payment for MacKay’s recent visits and procedures. They asked for every penny they had paid for MacKay’s treatment since Cigna had taken control of administering the health insurance for USM faculty, their spouses and domestic partners just a few months earlier. And none of this would have happened if Cameron and MacKay were married.

Cigna took over administration of the faculty health insurance policy on Jan. 1 of this year after a decision to do so by the Board of Trustees. Anthem had overseen the policy for many years, and the change to Cigna caused quite a stir. Cameron herself was an outspoken opponent. She had heard a lot of negative things about Cigna and didn’t think that claims to the same level of service were going to hold true in practice. “They just don’t pay!” she said. It seems her concern was well-founded. Cameron and MacKay’s domestic partnership seemed to be the main issue for Cigna’s claims department. Federal law does not recognize domestic partnership. However flimsy it might be, this was the legal basis for Cigna’s argument. Their claim was that since MacKay was over the age of 65, and not a spouse under federal law, she should be covered by Medicare rather than Cigna as her primary provider. The contract between the Associated Faculties of the University of Maine and the University System is very specific though. It equates domestic partnership with a spouse for the purposes of benefits. This means that spouses are allowed to use the university as their primary provider regardless of age.

Perhaps the most frustrating component of Cameron’s conflict with Cigna is the looming decision on marriage equality in Maine. If Cameron and MacKay were legal spouses – a possibility if Question 1 passes – then a switch to Medicare for MacKay would never have been considered because the term is so clearly defined in civil law.

“You can see it’s not just a romantic issue,” said Cameron of Question 1. “It’s a civil act.” Cameron drew on her New England studies background for comparison. “The Puritans got married in front of a judge,” she said. “They called it a contract.”

Tracy Bigney is chief human resources and organization development officer for UMS. She oversees the contract that determines the extent of Cameron and MacKay’s health coverage. The AFUM policy is self-insured, meaning that Cigna only administers the plan laid out by the university, while the system is still the one paying all the claims.

“We don’t get involved in any individual claims,” Bigney said of her office, but they do address any conflicts with Cigna’s interpretation of the contract. “We tell Cigna what to do.”

Without any direction to do so by the university system,  Bigney did some digging after Cigna started to ask for their money back. She found that the portion of the contract that equated domestic partnership with marriage had been “administered inconsistently,” according to Bigney, even when Anthem was in charge. Cameron’s case was showing that the need for clarification on the terms of domestic partner coverage over the age of 65 was urgent – so urgent, in fact, that Cameron and MacKay had to wait for a board of trustees meeting to find out if MacKay was insured or not.

That meeting happened last weekend in Presque Isle and Cameron’s fears had been eased a little before that. “We don’t have to do any payback,” Cameron said. “Tracy assured me all those benefits,” she said referring to the payments that Cigna was demanding back. And as luck would have it, they get to keep all their benefits. The Board of Trustees decided that UMS will remain the primary insurer for domestic partners over the age of 65, regardless of the lack of a federal precedent. “We finally got all the necessary information and all the right people in the room,” said Bigney of the emerging clarifications, adding that they have communicated this to Cigna.

It appears this chapter of Cameron and MacKay’s struggle is over. MacKay can continue to count on her cancer treatments being covered. Still unresolved, however, is the ongoing disparity between the legal attempts to create a replacement for the civic role of marriage in the LGBT community. Maine voters will have a chance to address this on Tuesday, Nov. 6 with their answer to Question 1.

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