special permission by Jo Joshua Godfrey
Jo Joshua Godfrey and daughters
The story Jo Joshua Godfrey tells seems like fiction. Sadly, her story of how her life was changed by a powerful insurance company is true. Her story starts in 1992 when she first fell ill with cancer.
In 1992 Mrs. Godfrey was a member of CIGNA health care insurance and a patient at one of their California clinics. A little-known fact is that at the time CIGNA owned 29 clinics in California.
When Godfrey first started having trouble in 1992, the CIGNA doctors told her she had bronchitis. That diagnosis was stated repeatedly even as the woman grew more ill. For two years she visited the clinic hoping that the doctors would find the cause of her breathing difficulties, but to no avail. She was desperate enough to ask for her medical records so she could visit a doctor outside of her plan. An insider from CIGNA gave them to her, she says.
In the end Godfrey ended up in a hospital at 9 p.m. one evening, and met a doctor she met through the Yellow Pages. This doctor who scanned her records, and within 30 seconds she had her diagnosis -- cancer. The proof was within the pages of her records, the doctor told her. It took her two years to discover the truth. She again had to fight to have surgery. CIGNA wanted her to visit another one of their doctors who again said she didn't have cancer. She fought harder.
Her surgery took place in September 1994. Her surgeon told her that she had a very rare type of cancer, with only 1 per cent of this type of cancer she had originating in the lung. "CIGNA said I wasn't a candidate for surgery," she says, adding how the tumor was choking her, closing the bronchious in addition to being very close to the heart. That was the cause of her having so much difficulty breathing.
CIGNA did not want to pay for the surgery that had saved her life, Godfrey says. Her doctor had to write down orders as she left the hospital for what was needed for her to stay alive. He said because the cancer originated in the lung, there were many tests to determine if she had cancer elsewhere, including brain scans and bone scans. "I was told CIGNA wouldn't want pay for it," she says. CIGNA documented the tumor was benign and would need a follow-up X-ray.
She went to the CIGNA's headquarters in Glendale (where care is administered to 600,000 people enrolled in CIGNA) in her hospital gown and slippers where she was met by the risk manager and a lawyer. The risk manager informed her there would be no visits to any outside doctors.
"It was a horrible experience," Godfrey exclaimed. "Why bring a risk manager and a lawyer?"
Godfrey's father was with his daughter as the risk manager started to tell Godfrey what would be allowed.
"If you don't treat my daughter, I will lift you and throw you through the glass windows and onto the street," he said.
Her father, angry already that his daughter's life had been in jeopardy, put his foot down. That wasn't enough. Godfrey didn't have time to play around, she went to the media. All of a sudden she was allowed to have the needed treatment and CIGNA agreed to pay for it. That's what they told the media at least. Godfrey thought that the insurance nightmare was over, when in fact she was just in the beginning stage.
The bills were not paid. But CIGNA was ordered by the state to pay for those doctor bills.
Knowing the problems that she had, Godfrey ordered that the medical records of her family be released so an outside doctor could examine them.
It was a positive move. Her 14-year-old daughter had been having headaches. The doctors at CIGNA had told Godfrey for years that nothing was wrong, but again that wasn't the truth, Godfrey recalls. Godfrey's daughter had a diseased bone that was pushing towards the orbit of her eye, and without surgery she would go blind. Her surgery was performed a month after Godfrey's tumor was removed. She can see today because of it.
The Godfrey family had one more shock. Mr. Godfrey survived the Vietnam War where he was granted a Purple Heart, but had a spot on his lung. The spot had been found during a 1992/1993 physical that was part of his job. At the time he was employed as the Chief of police at the Department of Veterans Affairs in Sepulveda, California, as well as a detective at West L.A., Assistant chief in Palo Alto/ Menlo Park and finally chief of police in Las Vegas, Nevada. He took the X-ray to his CIGNA doctor who told him nothing was wrong. The fact is that the doctor refused to look at it. The doctor did another X-ray, and told him there's nothing wrong with him.
"It's probably just a smudge," Godfrey told me the doctor said.
In late 1993 he underwent a complete physical at CIGNA and told he had a clean bill of health. They were wrong. He was already very ill and needed to have the tumor monitored every 60 days.
At one point during this mess Jo went to get the clinic pharmacy to get her medication, knowing that her co-pay would be $2. She was told she had to pay much more than that, around $68. When she stood her ground about paying the standard price she claims that the pharmacist came out of the drug area to slap her, screaming that she was "nothing but trouble for our company." A CIGNA doctor recommended that Godfrey would have to pay full price. "They just this to torture me," Godfrey recalls.
During this period Godfrey's oldest two daughters were in university at UC Santa Barbara. Instead of CIGNA assigning the girls a doctor in Santa Barbara they were given a doctor in Santa Maria, an hour and a half away. When the family asked how this could happen state regulators wrote CIGNA a letter to give the girls a closer doctor. CIGNA then assigned them doctors that no longer worked with the insurance company's plan.
Godfrey was through, she wanted to get a new carrier. Lawsuits have been filed, not for the money but to get CIGNA to stop their policies that are killing people, in Godfrey's opinion. "They forced me into binding arbitration, but I refuse to arbitrate with a criminal," she says. She adds that CIGNA demanded from the arbitrator she would have to pay their legal costs.
The case was dismissed because Godfrey wouldn't agree to arbitration.
At one point she was told there was another tumor in her lung and she needed surgery. Godfrey fought for a second opinion. That doctor told her that there was no tumor and had she had the surgery that CIGNA wanted to have, she would have died.
Godfrey tells me that the doctor told her "you can't lose any more of your lung or you will die."
After many hurdles today Godfrey is with Blue Cross and couldn't be happier.
"Blue Cross has always treated me right. I want to let it be known that corporations own our country, people have no voice," she adds.
The good news is that the Godfrey family is now healthy and have health care that they can trust. Godfrey wants health care reform to become a reality.
The Godfrey's story is not the only one coming out about the CIGNA doctors. Virgie Spence lost her husband when the same system couldn't find out what was wrong with Bill. He had Stage 4 non-Hodgkin lymphoma and passed away in 2009, despite his diagnosis occurring in 1993.
Mrs. Spence does not say outright that CIGNA doctors were trying to cut costs but she admits that for two years the CIGNA doctors could not find out what was wrong. Worried about her husband's failing health she went out of network to The Simpson Medical Clinic in Santa Barbara in 1993. The first night at the hospital the ENT specialist gave the couple a preliminary diagnosis that was confirmed within three days by a biopsy. Those three days saved his life. He sadly passed away last year from a repeat of the same disease but he had 15 years of relative good health in between.
At first CIGNA tried to not pay for Spence's out-of-network bills, but after countless meetings the bills were paid. Once Spence was in remission the couple obtained a different carrier for their future medical needs.
"At the end I wasn't happy with the insurance. At a certain age they don't seem to care for you. Your older, your health is failing."
I asked Mrs. Spence, who now resides in Las Vegas, what her views on today's health care reform:
"I'm for it. It's simple, what we have now is not working for us. I am willing to try something that may work. No insurance is going to be perfect for everybody but something has to be done."
During their hardships with CIGNA Godfrey's husband doctor Dr. Thomas Conklin left CIGNA. He sent the following letter to his patients:
My involvement with HMOS within the last few years has allowed me to establish a warm rapport with many of you; but along with this rapport comes responsibility.
Often during my HMO experience, the decisions I had to make which I felt were in the best interest of my patients were overridden by the bureaucracy. In good conscience, I cannot treat my patients in this type of environment.
After much SOUL-SEARCHING, I have decided not to accept HMO-based insurance plans at this time.
In my twenty years of practice at this same Northridge location, I have seen many changes. Northridge hospital has grown from a small community-based hospital to a medical center, serving an expanding, diverse population. Despite the changes, the needs of the people remain the same. Everyone deserves quality health care.
When making future decisions regarding your family practice doctor, please consider me.
I called his office and spoke to his office manager Michael who confirmed that this is indeed the letter that was sent to his patients.
Mrs. Godfrey is committed to not allowing the big insurance company to get away with the hardships and possible deaths that are a result of their actions. She told me that some have asked her if she is afraid that by blowing her whistle loudly she could wind up dead. She chooses to take her chances and make sure her voice remains loud and strong.
In an earlier report on Godfrey I contacted insurance company CIGNA with a request for comment. CIGNA spokesman Chris Curran told me via email: "Because of HIPPA regulations, we are unable to discuss the details of Ms. Godfrey’s case without her permission. However, we can say that when Ms. Godfrey was enrolled with CIGNA more than a decade ago, she received all of the benefits to which she was entitled under her benefit plan. There was no denial of coverage."
I spoke to Dan Green of the
Federal Employees Health Benefits Program about the Godfrey case. He said that he did help Mrs. Godfrey with writing a letter so that she could obtain a new carrier.
"This is standard practice when there are impaired relationships with insurance companies," he says.
For more info, go to
www.UnitedPatientsOfAmerica.org
