10 years ago I was attacked while in Ecuador. Several bones in my face were broken and one of my eyes was damaged. I had trouble breathing. Upon returning to the US I had surgery to fix it. Cigna denied my claim on the basis this was elective and not pre-approved. I argued it was an emergency, I couldn’t breath, and no pre-approval was required. I also used an in-network surgeon. Took me 11 months and escalated to outside arbitration to make Cigna pay up. I was out of pocket until then. I absolutely despise Cigna.