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
In 1989, CIGNA Healthcare of Arizona informed policyholders it would no longer cover long-term speech and physical therapy.
Three-year-old Ryan Ewers, who weighed 17 pounds and couldn't talk, eat or stand to have his skin touched because of complications at birth, needed those therapies for any hope of one day leading a normal life.
Luckily for Ryan, his parents made a commitment to continue his therapy, regardless of financial hardship. Karen and Randy Ewers took out loans, worked extra hard and led a Spartan life. Karen's parents chipped in. They estimate the insurance would have paid for $50,000 worth of therapy.
Therapists believed Ryan might never talk or ride a bike.
Now 15-year-old Ryan drives his mother nuts asking if he can go out and ride his bike.
There may be dozens if not hundreds of other developmentally disabled children who stopped receiving therapy benefits because of the 1989 CIGNA policy change.
There is now strong evidence that those benefits were removed illegally from the policy covering Ryan Ewers.
Karen Ewers began piecing together that evidence back in late 1995, when she called CIGNA to complain about the family's new $779 monthly insurance premiums.
The CPA and former supervisor with the state Auditor General's Office just figured she was getting gouged.
But CIGNA's strange reaction to her complaint, and its refusal to turn over key documents in her records, left her with the lingering feeling that key facts were being hidden from her.
Now, after a six-year journey through stonewalls, lawyerly obfuscation and the numbingly esoteric world of insurance law and regulation, Ewers says she has rebuilt a clear picture of reality:
That in 1989, CIGNA Healthcare of Arizona removed speech and physical therapy benefits from its individual conversion plans without first obtaining approval from the state Department of Insurance, a violation of state law. (CIGNA officials countered that it is their standard business practice to obtain the approval.)
That on at least two occasions, the insurance company changed the Ewerses' policy significantly prior to filing those changes with the Department of Insurance, another violation of state law.
That by not legally removing speech and physical therapy benefits from its conversion policy, CIGNA still owes the parents of dozens if not hundreds of handicapped children for all unpaid therapy since 1989.
CIGNA countered in a letter to New Times that "it is CIGNA Healthcare's standard business practice to file its plan service agreements for review and approval by the Arizona Department of Insurance prior to use. For this reason, CIGNA Healthcare would have obtained Arizona Department of Insurance approval for form ISAC 92-001 and other individual conversion plan and HMO service agreements before they were implemented."
Ewers believes one document, CIGNA's 1991 master contract for conversion policies, could explain what happened to those missing benefits.
But Ewers says CIGNA never gave her a copy of the contract in 1991 and it refuses to give it to her today.
For the last five years, CIGNA has denied Ewers' requests for a copy of the contract. CIGNA also denied a New Times request for the contract.
And two years ago, a copy of the contract on file at the Arizona Department of Insurance was destroyed just days after Ewers says she made an appointment with department secretaries to review it.
Then department officials told Ewers they had no power to request the contract for her from CIGNA.
Ewers believes she has stumbled on a 12-year-old skeleton in both CIGNA and the Department of Insurance's closet.
New Times' own two-month investigation supports her theory.
"They messed up in 1989," Ewers says. "Then I believe they've done everything they could to not deal with the fact they messed up.
"Because of that, I believe there are other parents who are entitled to benefits. My hope is they can recover something to put away for their children's futures. And then maybe something good can come from CIGNA acting in such bad faith."
After 48 hours of labor, Ryan Ewers was born February 1, 1986, with his umbilical cord cinched around his neck.
He and his family would have to build a life for him around a half-suffocated brain.
He vomited his food. He was fed through tubes until surgery and physical therapy helped him tolerate eating.
His ears were constantly infected, so tubes were inserted to drain fluid. One eye drooped, so doctors built him eyelid slings built from muscle in his leg.
He began walking once his eye was fixed. He walked like a man on stilts, so therapists and family members worked to loosen his taut ligaments and tendons.
It appeared he would spend life as a mute until one week in the summer of 1995 he began speaking little words as clear as bell tones.
"Apparently, his brain rewired and he found a way to speak," Karen says. "Some therapists said it wouldn't happen. Then there he was chatting away."
But caring for kids like Ryan isn't cheap. By the late 1980s, it was increasingly difficult for companies such as CIGNA to turn profits selling policies to families with chronically ill children.
Back in 1983, when the Ewerses first started with CIGNA, insurance companies seemed desperate to give policyholders anything they might ever need. At the time, companies were scrambling to get cash they could invest. While an insurance company in the mid-1980s might break even between premiums and payouts, it could be making 20 percent or more on investments, particularly real estate, while it held that money.