A tiny semantic tweak

Published July 2, 2025

After 30 years of pain and all sorts of failed attempts at “fixes,” I finally got an orthopedic surgeon to say, ‘Yes, you quality for a total knee replacement.’ (In fact, I qualify for two — but one at a time, please.)

I had been told I was too young and that I hadn’t tried everything else to deal with it first. But with all the boxes now checked, finally I’m scheduled for surgery on July 21.

Assuming, of course, my health insurer approves. Oh, yay.

And, in fact, Cigna (or, rather, whatever company Cigna outsources decisions to) declined to pay for the surgery. The cryptic denial message mentioned something about it being an inpatient procedure. 

I left a message with the doc’s office; this must be par for the course. I got ready to do battle. But half a day later, I got a call back: Cigna agreed to cover it. Oh, yay!

What happened?

Get this: Cigna said a total knee replacement should be an outpatient procedure. So my doc changed the request from something like ‘Inpatient knee replacement’ to ‘Knee replacement followed by overnight hospital stay,’ and that was enough to allow for coverage.

For some reason, I feel like no human was actually involved in the decision making. One small semantic tweak was enough to convince someone or something to cover the surgery I need. Go figure.

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