An Open Letter to Cigna

Dear Cigna,

My name is Kate Browne, and I am a Cigna policyholder through the third party payer Benefit Administrative Systems.

I am also a runner, and I am training for the 2018 25th Anniversary #runDisney Dopey Challenge, which will be my biggest running milestone to date.

In 2016, I was diagnosed with Stage II/III lipedema, a chronic, progressive disease characterized by bilateral, symmetrical fatty tissue excess, mainly in the hip region, upper and lower leg areas and combined with a tendency for leg swelling that worsens with standing (more info at http://www.fatdisorders.org/). When I first noticed pain and swelling symptoms were affecting my quality of life in 2012, both my primary care physician and gynecologist prescribed treatment protocols for general edema and obesity. My primary care doctor also recommended a very extensive, very expensive battery of tests to rule out heart disease that would explain the swelling. My heart was found to be in perfect working order. The prescribed treatments—wear compression and lose weight—had no effect on my leg pain, which actually worsened after pregnancy.

In 2016, I sought treatment for pain and swelling in my legs again, and the same primary care physician now diagnosed the swelling as lymphedema and prescribed physical therapy. You may not know this—I did not at the time—but lipedema is a condition regularly addressed in physical therapy training due to its effect on the lymphatic system. My physical therapist diagnosed lipedema on my first visit. This new information led me to the office of Dr. Donald Buck, a respected expert in fat disorder research and plastic surgery. He confirmed that my symptoms, medical history, and clinical presentation were consistent with the lipedema diagnosis, and subsequently recommended tumescent liposuction as an appropriate treatment. Due to my advanced stage, I was quickly approaching a severity at which conservative and surgical treatments would be less effective or have no effect on slowing or stopping its progression.

At this point, I’d like to mention that when Cigna claims representatives and the external appeal board reviewed my case, they stated that I had been misdiagnosed with lipedema. However, the research they cited to define the clinical presentation and proper diagnostic protocol was co-written by Dr. Buck, which betrays both faulty logic and a lack of attention to detail.

Although I sought medical treatment for pain and swelling in my legs beginning in 2012, I received no relief due to improper diagnosis. When I made the decision to pursue surgical treatment, my lipedema had already progressed to the point where my inability to do everyday tasks began to interfere with my quality of life. I woke up every day with a burning pain in my calves, and could not stand for more than 30 minutes. At the end of the day, my legs would swell so much that I could not wear pants comfortably. Running became impossible due to the physical disfigurement caused by lipomas around my knees as well as heaviness, pain, and swelling exacerbated by even small amounts of physical activity. I severely limited my social activities due to fatigue and pain. My clinical depression worsened and began to affect my ability to work. Tumescent liposuction offered a solution not only to alleviate pain and relieve pressure on my lymphatic system, but also to restore my hope for the healthy, active life I wanted. Considering that other treatments had not been effective in slowing the progression of this disease, moving forward with the surgeries as soon as possible emerged as a clear next step.

A reduction in pain occurred almost immediately after my first surgery on July 5, 2016. I maintained the prescribed protocol of physical therapy and compression during my recovery period, and went on to have two additional surgeries recommended by Dr. Buck on August 16 and September 27. Even though Dr. Buck is an in-network Cigna provider with a plastic surgery specialization, Cigna denied coverage for these procedures according to policy document 0470—Redundant Skin Surgery based on the determination that all liposuction is a cosmetic procedure. My attempts at an appeal have been unsuccessful because Cigna representatives have neglected to review my employer’s policy language that covers cosmetic surgery “if the surgery is required to correct a condition that results from an illness.” The disfigurement and subsequent loss of mobility that occurred because of my lipomas should have been reason enough to consider these surgeries covered as a treatment for an illness according to my employer’s policy, but I was continually denied based only on Cigna’s policy 0470.

While my ultimate goal is to receive coverage for the benefits to which I am entitled, I did not write this letter only to challenge the appeal decision made by Cigna’s representatives. There is a bigger issue at stake that I would also like to address in my letter today.

Since I have fully recovered from my surgeries, the pain associated with my lipedema has been completely resolved, and I successfully treat my edema with rest and compression. In other words, my life has been restored. I have resumed all of my everyday activities without pain, and serve as a leader in many athletic communities as a mentor for beginner athletes. I model a healthy, active lifestyle for my son and I can participate in the swimming, running, and gymnastics activities that have become an important part of his life. Also, as I mentioned previously, I am training for my first half and full marathon.

I need you to understand that having these surgeries is what makes it possible for me to participate in the 2018 Walt Disney World® Marathon Weekend, but I cannot stay silent in the face of the irony that is Cigna’s denial of coverage.

Cigna is the official sponsor of the 2018 Walt Disney World® Marathon Weekend. According to your website (https://www.cigna.com/about-us/events-and-sponsorships/), this is what you say this sponsorship stands for:

“Cigna is intently focused on helping people improve their health and well-being. Presenting this event with Disney enables us to reach thousands of people and celebrate their efforts to adopt a healthy lifestyle.”

 

“Cigna understands that meeting a fitness milestone — whether it’s running a race for the first time or meeting personal race goals at any length — is cause for celebration.”

 

“To us, health is intertwined with a sense of well-being and security. Our relationship with the people we serve goes deeper than coverage and claims.

 

It’s about understanding the obstacles people face in trying to lead a healthier life, then helping them overcome those barriers and change their habits.

 

It’s about understanding that healthier people are more productive, enjoy a better quality of life and lower costs for everyone within the health care system.”

I am now asking you to prove it.

Prove that you truly do care about serving your customers and helping them live a healthy, active lifestyle. Prove that when the barrier to an active lifestyle is coverage and claims that you will put your money where your website copy is.

It is estimated that 11% of women in the U.S. live with lipedema, and Cigna regularly denies coverage for liposuction procedures that would restore mobility and improve quality of life, which would lead to better overall health outcomes and lower insurance costs. In my case, I am eligible for coverage through a clause in my employer’s policy, and because Cigna claims representatives did not take information into account at any point when determining my coverage eligibility, I have waited over a year to receive the benefits to which I am entitled.

Now, I am training for the Marathon Weekend, an event that my brother and several of my friends participate in annually. My brother’s participation in past years and my participation this year has inspired other members of our family to also join for some of the races—an unprecedented commitment by our family to make exercise not just a hobby, but a true family activity that we never would have imagined being a part of our story 25 years ago when we first went to Walt Disney World. Yes, our first time at Disney was the same year as the first Marathon Weekend.

My family shares your goal for Marathon Weekend as we “combine fun, family and physical activity in a magical way” this January. But the unconscionable denial of coverage for my surgeries is a gross insult, and has negatively impacted my training experience and my perception of Cigna’s sponsorship of this event.

I hope that we can come to a resolution that will allow me to train for and participate in Marathon Weekend secure in the knowledge that Cigna keeps its promises to “meet people’s emotional, physical and financial needs—for a lifetime.”

I am the founder of Taking Up Space, a platform I use to advocate for body positive, inclusive fitness through access to meaningful resources that allow for the most participation in exercise activities for as many people as possible. My work has been featured in US News & World Report and Refinery29, and I regularly engage with brands to change policies and marketing practices that deny access to fitness based on body size, shape, or configuration. Most recently, I worked with the LifeTime Fitness and Geico to rewrite biased print advertising, which improved the reputation of both companies for my followers and the thousands of people reached by my message.

I am offering you an opportunity to make this situation right. I would much prefer to tell my followers that contrary to the perception of insurance companies as uncaring, faceless corporations that use a rhetoric of compassion to masquerade a singular, demonic focus on profit, that Cigna does care about its customers and supports personal journeys that lead to active, healthy lifestyles. I want to be an example of how health care and health habits can work together to change lives for the better. But I cannot do that while the obstacle of inhumane policy documents, ineffective customer service, and stoic rejection letters continue to deny me the coverage to which I am entitled.

In case it was not very clear, I am not trying to receive fraudulent benefits; I am seeking coverage for the benefits to which I am entitled according to provisions in my employer’s policy. Like the conservative treatments for lipedema that have been prescribed by my primary care physician, physical therapist, and Dr. Buck including wearing compression garments, using a pneumatic pump, and physical therapy that I continue to utilize to treat my lipedema, the surgeries represent a legitimate medical expense. As such, I should be reimbursed according to the covered benefits provided to me by my employer’s policy.

I am ready and willing to work with Cigna not only to provide the information necessary to reach a positive resolution for my claims, but also to be a public supporter of Cigna’s sponsorship of the 2018 Walt Disney World® Marathon Weekend. Once I receive full reimbursements for my claims, I will gladly include a Disney-worthy happily ever after in which Cigna heroically steps up and fulfills its promise to support its customers. I hope you mean it when you say “when people are…managing a chronic disease…we are at their side, around the world, helping them improve their health and well-being.”

Starting today, any training-related post I make on Instagram (@takeupspacewithkate) or on my Facebook page (https://www.facebook.com/takeupspacewithkate/) will reference the fact that my coverage continues to be denied and that my experience preparing for Marathon Weekend has been negatively impacted by this denial until such time as my appeal has been overturned.

My entire case file contains more than 250 pages, but I can provide any additional information required to move forward with this appeal. If you would like to speak with me personally, you can reach me at kate [at] katebrowne.net or by phone at the number on file.

I look forward to a day in the very near future when I can start to train for the Dopey Challenge with wholehearted and joyful enthusiasm, and prove to myself, my family, and my followers that putting health first is work worth doing. Thank you for your attention and careful consideration of my story. I trust that I will hear from one of your representatives soon.

 

Sincerely,

Dr. Kate Browne

Founder, Taking Up Space

Radical Visibility and the Myth of the Bikini Body

The idea of a “bikini body” is a grand metaphor for a body worthy of being seen. Slenderella International, a short-lived chain of weight loss salons, popularized the phrase in 1961. The company ran a series of ads in major newspapers like the New York Times and the Washington Post. “Summer’s wonderful fun is for those who look young,” they claimed. “High firm bust — hand span waist — trim, firm hips — slender graceful legs — a Bikini body!”

Hand. Span. Waist.

You might be rolling your eyes and feeling a little nauseous at that line, but I bet you also believe in the bikini body.

I know you do. Just a little bit. A hand span’s worth.

How could you not? It’s been part of the American culture imagination for over 50 years. Two generations and counting of an unshakable commitment to doling out access to beaches and sunshine based on how young, light, tight, tanned, and firm women’s bodies look.

I could talk all day about how the bikini body ideal has deeply hurt women by perpetuating a cycle of self-hate and socialized body surveillance, but that’s been done better elsewhere at places like Everyday Feminism (here, here, and here) and Fit Is a Feminist Issue. This delightful video from Bustle takes it a step further by modeling what a multi-variant body pool party might look like (p.s. I want to go there!)

But there’s something about the bikini body clapback that bothers me.

For some reason, #bodypositivity has taken up the Unconditional Bikini Body as the ultimate symbol of self-acceptance and body love. The message, even from well meaning and woke feminists, is that wearing a bikini in public is the most radical resistance to aspirational beauty ideals, body shaming, and the patriarchy itself. For some women, doing the emotional work to rock a two-piece in the body they have now might be a valuable and righteous form of self-expression. For others, you might as well suggest that they take a rowboat to the moon: an impossible, unappealing, and absurd task.

Bikinis, as a piece of clothing, aren’t even available to all women. Some women choose not to wear them for religious reasons, they aren’t available in all sizes, and prosthetics/medical accessories don’t always jive with a more revealing swimsuit style.

When you give one act of resistance such symbolic power, those who can’t or don’t want to are left out. It doesn’t mean these women don’t love themselves enough, or that their choice *must* by a by-product of internalized oppression.

blonde woman shaking her head surrounded by the word no

That’s where I think our love affair with the Unconditional Bikini Body can really go off the rails—when women are pressured to perform radical self-love without acknowledging and attending to the risks that come with it. For many women, being visible is a vulnerable act because they have been told over and over and over throughout their lives that there are certain bodies that shouldn’t be seen. When you come to understand your relationship to the world in this environment, you know, without ever even stepping in front of a fitting room mirror, when your body does not fit the criteria. So, for lots of women, the possibility of wearing a bikini in public has always been a row to the moon.

I understand, appreciate, and commend feminist endeavors to reassure women that the bikini body is a myth and that all bodies deserve the right to be visible. But it makes no sense to me to suggest that women should feel empowered and free to wear any piece of clothing, let alone such a revealing one, without being really, really clear about what exactly makes visibility so radical.

I adore looking at pics of women on IG crushing it with mad poolside style in their Unconditional Bikini Body because representation matters. If “wear a bikini to the beach” is something you want to do, it can feel so good to see someone who looks like you doing the thing. But posting on social media requires an incredibly high level of resilience that isn’t readily available to most women. Modeling what a shame-free culture could look like—in all its stretch mark, cellulite, belly roll glory—is admirable not because these women are “brave enough” to be seen, but because they are doing the emotional work it takes to be visible in a body they have been told does not deserve to be seen. They show, by their presence in our real life and online spaces, that resistance to diet culture is possible in this very specific way.

Wearing a bikini doesn’t make you invisible. It does not give you immunity from other people’s diet culture cruelty through special No Fucks Given superpowers. Just because the beachy beauties of IG give us the gift of radical visibility doesn’t mean that anyone has an obligation to wear a seashell bra this summer, nor should we assume that women who do love themselves more than those who don’t.

It doesn’t matter if you can’t wait to hit the beach in your bikini this summer or look forward to beating the heat from the comfort of the air conditioning, because we all have a responsibility to talk about our bodies and the bodies of others in a way that supports inclusion and safety in all our public spaces. It’s not up to the individual woman to summon her own bravery and wear the bikini–it’s up to all of us all year long to show up for radical visibility.

 

I am committed to supporting every woman out there living in the Northern hemisphere who has a visibility goal this summer. No more #suffersummer! If you’ve been avoiding warm weather outdoor activities because you’re afraid of being seen, I want you to join my upcoming Show Up for Summer program. Sign up below to be the first to know when it drops (it’s coming soon!). I’m rooting for you!

 

Sources:

Robb, Alice. “Why Can’t We Stop Talking About Bikini Bodies?” The Cut 23 July 2014. http://nymag.com/thecut/2014/07/why-cant-we-stop-talking-about-bikini-bodies.html

Work Worth Doing: Self-Care as Activism

It’s a strange time to deposit a literature PhD dissertation.

I finished the final draft in the last hours of 2016, nearly crushed by the weight of the knowledge that the project I poured every available ounce of my energy into for the past 5 years means very little in the grand scheme of things.

Who cares about diet culture when human rights are increasingly at risk?

And yet, diet culture is nothing but human rights.

Diet culture seeks to strip us of autonomy, of connection, of pleasure, and of potential. Among other things. It is not a separate entity from racism, misogyny, transphobia, disability discrimination, and reproductive rights (as none of these exist separately from each other). Indeed, the personal is very much political.

And yet, I spent nearly the entire day after the Women’s March on Washington feeling like I’d done less than I could because I didn’t march. Instead, I updated my website and planned my forthcoming online course for body image renegades. It seemed like small, insignificant work. I wondered if I should quit to do bigger, bolder, more “political” work.

In these moments of crisis, I turn–as I always do–to smarter women. I needed two this time.

First, I turned to Betty White, who refused to be baited by Katie Couric in an interview about our starkly divided nation.

 

We’re not in the best place we’ve ever been. That’s the time to buckle down and really work positively as much as you can. Instead of saying, ‘Oh, this is terrible. He’s terrible,’ just think, ‘All right, there’s nothing I can do about that right now. But I can do the best in my little circle. So if I do that, maybe you’ll do your best. And we’ll get through this.’

We all have to choose where we put our energy, and sometimes that leads to a sense of helplessness when we can’t affect change in all the areas that need it. And, sometimes the reach of our energy seems small, especially when we see others doing more public activism. If you feel like that too, listen to Betty–if you do your best, that might help someone do their best. And that’s worth a lot.

Then, I took that bit of wisdom and combined it with the words of Audre Lorde, one of the first black women whose writing had a profound impact on my worldview. In a well-known quote about self-care from the epilogue of A Burst of Light, Lorde denies self-care as an indulgence (aka the self-care of White Feminism), insisting instead on its inherent value as bodily preservation to be an act of “political warfare.”

Quote from Audre Lorde: caring for myself is not a self-indulgence, it is self-preservation, and that is an act of political warfare."

If you’ve never read this quote before, I’d like to ask you to read it again. Slowly. Carefully. There are many interpretations for this quote, but for me the most important message is that when powerful people and institutions want to destroy your body–and “destroy” is meant very literally–caring for that body is an act of resistance akin to political warfare.

I also turned to one of my favorite parts of Lorde’s The Cancer Journals, a book that is on my must-read list for anyone, ever:

Each of us is here now because in one way or another we share a commitment to language and to the power of language, and to the reclaiming of that language which has been made to work against us. In the transformation of silence into language and action, it is vitally necessary for each one of us to establish or examine her function in that transformation, and to recognize her role as vital within that transformation.

For those of us who write, it is necessary to scrutinize not only the truth of what we speak, but the truth of that language by which we speak it. For others, it is to share and spread also those words that are meaningful to us. But primarily for us all, it is necessary to teach by living and speaking those truths which we believe and know beyond understanding. Because in this way alone we can survive, by taking part in a process of life that is creative and continuing, that is growth.

Emphasis mine.

It is necessary to teach by living.

So, doing the best in my circle to teach by living means:

animation of a heart shaped, cartoon burger being assembled and winking

I’ll do the best I can. You do the best you can. The work is worth doing and it matters. Your work is enough.

 

p.s. the links to Lorde’s books are affiliate links. Audre Lorde’s books are also available at many public and university libraries.

p.p.s. My online course, Already Extraordinary, is going to be INCREDIBLE. Sign up below if you want to be the first to know when it’s ready.