09/17/2025
Advocacy Works: How Collective Voices Change Healthcare Policy
When patients, physicians, and professional organizations speak up, health insurers listen. One recent example highlights the power of advocacy and public outcry to reverse misguided payer decisions.
The Cigna CPT 99459 Reversal
Earlier this year, Cigna announced it would not reimburse CPT 99459 (the pelvic exam code) when billed with problem-focused visits. For OB/GYN practices, this was a major blow: pelvic and breast exams are essential parts of women’s preventive and problem-based care, and the policy effectively devalued that work.
Physicians and practices raised the alarm, patients voiced concerns, and the American College of Obstetricians and Gynecologists (ACOG) mobilized. Through coordinated advocacy—emails, letters, and direct conversations with Cigna leadership—the message was clear: this policy harmed women’s healthcare access. Within weeks, Cigna reversed course, restoring coverage for 99459 when billed appropriately.
Other Examples of Advocacy in Action
· UnitedHealthcare and Modifier 25
UnitedHealthcare once attempted to cut reimbursement for evaluation and management (E/M) office visit services billed with modifier 25 on the same day as a minor procedure. Physicians argued that this would force patients into multiple visits for issues that could be handled in one encounter. After outcry from specialty societies and patient groups, UHC scrapped the policy before it went into effect.
· Anthem and Emergency Room Coverage
Anthem Blue Cross Blue Shield announced it would deny coverage for certain ER visits it deemed “non-emergent,” even if patients reasonably thought they were experiencing an emergency. Public backlash was immediate—patients, advocacy groups, and even lawmakers demanded change. Facing lawsuits and regulatory pressure, Anthem rolled back the most restrictive parts of the policy in multiple states.
· Cigna and Colonoscopy Anesthesia Coverage
Cigna initially refused to cover anesthesia for screening colonoscopies unless deemed “medically necessary.” After patient advocacy groups, including the American Cancer Society, demonstrated how this barrier discouraged lifesaving screenings, Cigna reversed the policy and began covering anesthesia routinely.
· Aetna and Breast Reconstruction
Aetna once denied coverage for certain breast reconstruction procedures after mastectomy, calling them “cosmetic.” Breast cancer advocacy organizations fought back, pointing to the federal Women’s Health and Cancer Rights Act. The backlash forced Aetna to comply fully, expanding access to reconstruction coverage.
Why Advocacy Matters
These examples prove that advocacy works. When physicians, patients, and professional organizations unite, we can push back against harmful policies and ensure insurers are held accountable.
Physicians provide clinical expertise. Healthcare administrators provide the data. Patients share real-world stories that put a human face on policy changes. Professional organizations amplify those voices and engage payers directly.
Together, we can—and do—create change.
Call to Action
If you ever feel like one letter, one survey response, or one phone call doesn’t matter—think again. Advocacy is cumulative. Each voice adds to the chorus demanding fairness, access, and quality care.
The Cigna 99459 reversal is a recent victory, but it won’t be the last challenge. By continuing to speak up, we can ensure patient-centered care remains the standard.
Advocacy works. Always.
