By New Times
By Connor Radnovich
By Robrt L. Pela and Amy Silverman
By Ray Stern
By Keegan Hamilton
By Matthew Hendley
By Monica Alonzo
By Monica Alonzo
La Donna Sell was talking to her son when she set down the phone to answer the door. Suddenly, she fell to the floor, as one spasm after another surged through her body.
Writhing in convulsions, she lost consciousness. She had been struck by a grand mal seizure. La Donna's four dogs began barking wildly. Hearing the commotion through the phone line, her son hung up and called his father, Phoenix accountant Jim Sell.
"I told him, 'Look, I'll get in my car, and I'll head home, and you call the paramedics,'" Jim Sell says.
"When I got to the house, the sheriff was there and so were the paramedics, and she was unconscious," Jim Sell says.
If it hadn't been for the barking dogs and the phone call from her son, La Donna believes she almost certainly would have died on that September day four years ago.
Luckily, an emergency team had time to rush her to Maryvale Samaritan Hospital. There, she suffered another seizure before being admitted for a two-day stay.
Eventually, the Sells were able to piece together what had happened to her.
An epileptic, La Donna had been controlling her seizures with the medication Dilantin. A month before she was stricken, La Donna had refilled her prescription at a CIGNA HealthCare pharmacy in northwest Phoenix. The pharmacy, however, had messed up the order. Rather than Dilantin, she had been given Dyazide, a diuretic normally used to control water weight.
There was no way for her to know she had been given the wrong medicine.
"They had changed the shape of Dilantin once before, so I didn't think anything of it," La Donna says.
Five weeks of taking an unneeded diuretic had left La Donna weak and dehydrated. CIGNA physicians had been treating her for what they thought was the flu, while a combination of fluid loss and lack of seizure medicine worked on La Donna. Then the near-fatal wave of seizures ripped through her body.
Even after hospital doctors realized the Dilantin level in La Donna's bloodstream had plummeted to zero, they neglected to examine the prescription medication she had been taking. They didn't examine the medicine, even though Jim Sell had provided it to them.
"No one ever checked it," says La Donna. "In fact, they sent me home with the same bad medication."
Only after one of Jim Sell's acquaintances recognized the medication as a diuretic did CIGNA send the pills to a lab for analysis, La Donna says.
La Donna Sell survived the seizures, apparently without permanent damage to her health. In their aftermath, however, she has learned enough about the state's largest health insurance company to make anyone sick.
Rather than take responsibility for the prescription foul-up and cover all related medical costs, CIGNA adopted a penny-pinching policy in the Sells' case. It is a policy that may ultimately cost one of the nation's largest insurance companies millions of dollars.
CIGNA refused to pay a $317 ambulance bill associated with La Donna Sell's near-fatal seizure. The company took the position that La Donna should have called for authorization before seeking emergency medical care. That is, according to CIGNA, La Donna should have phoned for permission to call an ambulance, while she was lying unconscious with a grand mal seizure.
That Alice-in-Wonderland assertion infuriated La Donna's husband, Jim, who happens to be a professional financial analyst. He began asking questions.
Adopting a pit-bull-like approach to gaining information from Samaritan and CIGNA, Jim Sell soon discovered the ambulance bill was just one item in a large bag of CIGNA financial tricks.
Eventually, Sell found that CIGNA secretly negotiated discounts for Samaritan's services that weren't shared with CIGNA customers.
The effect of such one-sided discounts was to shift most of La Donna Sell's hospital costs from CIGNA to the Sells. In the Sells' case, the shift amounted to about $600. But the discount scam apparently has been played out hundreds of thousands of times across the country, by CIGNA and other large health insurers.
The amount of money at stake is, by all appearances, astronomical.
"This is how they screw the little guy," says Jim Sell. But he's not just another little guy.
CIGNA picked the wrong person to try to squeeze a few hundred dollars out of.
Jim Sell is an expert at sniffing out financial shenanigans. The government frequently hires his company, Sell Consulting Service Corporation, as a trustee to handle the affairs of companies that have filed bankruptcy or been seized by state regulators for violating laws.
He knows how financial games are played, and he's not afraid to exercise his rights as a consumer when it comes to health care. After enduring CIGNA's shabby treatment of his wife, Sell was more than a little suspicious. Then he learned that La Donna's two-day hospital bill was $4,533.75, even though the only treatment she received was Dilantin injections.
So when Samaritan began demanding he pay $906.75--the 20 percent share of the bill called for under his CIGNA insurance policy--Sell balked. Before paying the bill, he asked Samaritan to provide an itemized list of expenses for all services rendered at the hospital.