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One way I have encountered that CIGNA uses to control costs is their contracts with "preferred providers." Policyholders must use a doctor off the list to have their bills paid or pay all or part of the cost themselves (while paying $780 per month for COBRA this is difficult). Just this week I was on the phone for an hour trying to find a different doctor for a family member's mental health treatment. They only have eight in Madison, WI (population 233,000), and most of them are in the same practice (presumably they will accept the low rates of reimbursement CIGNA offers them). Her therapist recommended a doctor off the list, but upon calling her office I got several stories about whether she was a contracted provider. I have had many problems in the past with CIGNA's doctor lists being incorrect (they say they have providers who deny being part of the network or left the practice years ago)and the bookkeeper fessed up that the doctor no longer wants CIGNA patients and is trying to leave their network. Understandably, given their claims processing practices. So the "customer" is effectively stuck with one or two providers, who are willing to work cheap (the optometrist's equipment is all over 50 years old), and if you don't like them, too, too bad. Meanwhile on hold, you are treated to a repeated recording about drinking more water and how laughter is the best medicine (I do laugh while on the phone with them, but it's not happy laughter). I'm an attorney and just had a foreclosure mediation this morning with two self employed clients who are paying $880 per month for HIRSP because their COBRA (a steal at $680 per month) ran out. So they had to stop paying the mortgage on their home...our UNETHICAL health care financing system!