CIGNA Corporation

Review: October 2012- I needed a crown on a tooth, it was cracking, regular dentist unavailable, went elsewhere due to pain. That dental office had many issues, the crown they seated after a few visits broke within 24 hrs, I went back many times to try again. Finally, I said "don't do anything else, Im calling insurance to see my options, I don't trust y'all." Insurance told me to get them and myself reimbursed or I couldn't have the tooth fixed for 5 yrs. I did this, finally, through the help of the Revdex.com. I didn't have money to just go get it fixed so I needed to make sure this was covered and they had everything they needed to proceed. I was told on 4 different calls that Cigna had everything they needed and I could go get my tooth fixed, I made sure 4 times. I did, in July 2013 after having a temporary sitting on my tooth for 8 months, not even glued. I even had my dentist office talk to them to ensure we were all squared away. Then, I started getting the denial bills. I have made dozens of phone calls over the last year and a half, and everyone goes through the notes and sees all the details and says yes, this should have been paid. they kept re-filing, it gets denied again. Then, after two or three appeals I got another denial to my appeal, and the appeals coordinator even said this is bogus and doesn't understand why this keeps getting kicked back. Cigna has failed on many issues here. This is not acceptable.Desired Settlement: I want the insurance to just do what they repeatedly assured me they would do and pay the claim. Because of Cigna's failure to pay this claim, my dentist says we owe them over $850.00, after I paid my portion over a year ago and ensured repeatedly they would cover it. My reputation as a paying customer is ruined and I am embarrassed. So many hours wasted arguing this

Business

Response:

Hello-Thank you for forwarding this complaint. Cigna will review the customers complaint and follow-up directly with the customer.Tanya H[redacted]

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:I have still not been contacted by Cigna. There has been no resolution. This nightmare has now been going on for nearly two years. They need to pay the claim, like they repeatedly told me they would. Their business practices are atrocious!

Regards,

Review: We signed up for a Cigna PPO plan threw healthcare.gov back in April. The plan we selected was "myCigna Health Flex 5000"

This is advertised as a "Silver" tier ppo. Before we selected this plan we went to Cignas website to verify that all of

our local doctors took this specific plan. They all showed to accept Cigna ppo.Fast forward 4 months and we began to get

bills from our local doctors. With our plan a in network doctor is a 30 dollar co pay and deductible waived. We started to

go threw the bills and it showed all of our doctors were "out of network". I again went back to Cignas website and double

checked and it showed all our doctors were apart of the PPO network. So we call Cigna and were told that we needed to call

healthcare.gov since we bought the plan threw the market place. We then called them and they passed us right back to

Cigna. Once back on the line with Cigna I was informed that I did not sign up for a PPO but was on what they call "local plus"

I advised the agent from Cigna that I was looking right at the page on healthcare.gov and it said it was a PPO plan. She said

yes I do agree that is what it says but that is not what you are paying for. She instructed me that the healthcare.gov website

was incorrect and it was not a PPO. She said they were very aware of the issue. No where on anyone's website Cigna or Healthcare.gov

does it mention a "local plus" plan. I asked the Cigna agent what am I suppose to do when I was told I signed up for a PPO but do

not have it? She again advised me to call healthcare.gov since they cannot do anything and simply change the plan. Well thats great

for Cigna if I cancel, they have taken of $3,300 dollars of our money over the last 4 months and paid out nothing and on top of that

I am now left with well over $1000 dollars in unpaid medical bills that I am on the hook for. So I called healthcare.gov back and

informed the agent that I was told by Cigna that I was not on a PPO and the agent told me that was incorrect and that she would

open a claim for me. I was told it would take up to 30 days to get a reply back and if I cancelled the policy it took 16 days to take

effect. This is a 100% bait and switch and I found many many complaints on this same issue with Cigna online. I signed up almost

5 months ago and the agent at Cigna told me they were aware of the issue yet they still keep taking on new clients for this plan

and of course taking everyones money. This is just another typical big business stealing from its consumers and both parties pointing

the finger at each other not taking any blame.Desired Settlement: I would like my entire amount paid to Cigna refunded or to put me on the PPO plan that I signed up for and pay my outstanding bills that should have been paid by the PPO. You need to also get this plan removed everywhere so others do not go threw this very same hassle of bait and switch advertising.

Business

Response:

Revdex.com Complaint # [redacted] is dated 08-04-14.

We were not aware of it until 08-29-14.

I spoke with the customer today to let him know that we would be closing the Revdex.com as we are working on the same complaint received from another area.

I went out on the website to close it. I can no longer access the complaint.

I’m sending this email for documentation purposes.

Review: I got several canned emails, some saying "Final attempt", some claiming I have a bill. I replied back and never got a response back.

I got several canned emails, some saying "Final attempt", some claiming I have a bill. I replied back and never got a response back.

I got several canned emails,FROM "[redacted], Cigna Customer Account Specialist Team, Cigna Individual & Family Plans".

Some saying "Final attempt", "Response requested from Cigna" some claiming that Cigna sent me some important information, some claiming I have a bill ( when I paid for the year in advance), some asking me if I want dental insurance ( yes I might).

And I replied to all your emails and I never got a response back

I think this is very rude.

I want to confirm I am paid for the full year.

And I need to understand what was the "Final attempt" email for?Desired Settlement: I want to confirm I am paid for the full year.

And I need to understand what was the "Final attempt" email for?

Business

Response:

Good day,

A review has been completed and written correspondence has been issued to the customer with the outcome.

Thank-you.

Review: On Jan 20th, 2014, Cigna debited our bank account for our February premium $1703.46. They debited the account for the same amount again on Jan 21st, somehow by accident. I found out about the error and informed Cigna of the mistake on January 27th, they told me it would be 7-10 to fix the issue. I told them that was unacceptable, checks were being returned that I had already written and I asked to speak to a supervisor. After a 20 minute wait, they told me no supervisor was available, but one would call me back within 24 hours. No one returned my call.

I called back again on the 30th, with basically the same result. No supervisor to talk to, this time the person told me it would take 10-14 days to correct the issue, but they would try to accelerate it. Since then myself and my wife have called back 4 additional times, with no satisfactory results, no return of the funds and no logical explanation. I did talk to a supervisor in billing who told only accounting could handle this and I that accounting did not have phones. Seriously.

It has been 22 days now since they made the mistake and I still do not have my money back in my account. Today I called in and was (apparently) hung up on twice.Desired Settlement: Since we have had checks bounce because of this, we'd like Cigna to agree to pay for these charges and to notify our bank in writing that it was their error that caused the problem. And of course, we'd like a refund yesterday.

Business

Response:

Additional time is needed to review this case. A letter requesting an extension was sent to the customer on March 7, 2014.

Review: [redacted], NY [redacted] ###-###-#### 07/23/2014Re: Patient: [redacted]D: [redacted], DOB: 05/23/1988, Date of Service: 11/19/2013Procedure: OE, X-rays, Prophylaxis.Insurance company: Cigna PPO PO Box 188037 Chattanooga TN, 37422 Tel.####-###-####Unpaid amount: $148To whom it may concerned, I would like to file a complaint about unpaid claim in total of $148 by Cigna PPO insurance company for one of our patient [redacted]. On 11/19/2013 **. [redacted] came to our office for regular 6 month check up. She stated that she has Cigna PPO insurance and presented her insurance card. Our receptionists immediately called Cigna PPO insurance company to verify patient's benefits. One of insurance representatives, Ms.Debra, gave us full break down of benefits, assuring that patient is active. Dr. White, Kyle DDS performed all necessary treatment, based on insurance company covered benefits. All procedures were successfully completed. However, weeks later we received the payment denial for the procedures described earlier. After calling Cigna PPO representative regarding this issue, we were told that because their system was not updated at that moment they did not see that patient was not covered for that day of service. I think, it is unacceptable to supply providers with incorrect and not updated information without any responsibility for bills, which has to be covered. I insist CignaPPO insurance company pay this balance, since this is their mistake and they have to be responsible for information they provide. Thank you in advance for your assistance in resolving my problem.Sincerely, [redacted] DDSDesired Settlement: DesiredSettlementID: Refund

CignaPPO insurance company pay this balance, since this is their mistake and they have to be responsible for information they provide.

Review: My Cigna ID is [redacted], account number [redacted]

On 01/26/2013, I was charged $221.65 as my deductible for a procedure.

On 01/28/2013, I was charged $378.35 as my deductible for another procedure.

(with these two payments, I met my yearly 2013 deductible of $600.00)

I used my Flexible Spending Account card [redacted] card for these charges.

Both myself and the hospital have submitted all the necessary documents to Cigna and Cigna has covered both procedures. The information both myself and the hospital have submitted clearly showed that I had a deductible of $600.00 for 2013. Yet, Cigna keeps sending me letters asking to supply the documentation (for the claims they have already processed!) and threatening to deactivate my FSA Cigna card.Desired Settlement: Close the case and re-activate my FSA Cigna card as Cigna already has all the necessary documentation - and they have already processed the claims (which showed that I have paid $600.00 as my deductible.)

Business

Response:

Please note that our final response was sent to the customer on 10/17/2013 via mail.

Thank you.

Review: There is a claim by [redacted] on 4/3/2014, amount $130.17. It should be paid by Cigna out of my HRA account. They have not paid after 6 month

I had a service on 4/3/14 in [redacted] in [redacted] MA. They filed the claim on 4/8/14. However, [redacted] has never received the payment of $130.17 from Cigna as supposed to be. Cigna has claimed that there is an error in sending out the check. But they still have not fixed it and paid the amount after 6 months. Meanwhile I had called nearly every months since Now this amount has been gone to 'collection department' and I received bills and phone calls often. This is definitely affecting my credit. It is an unbearable service Cigna provides to its customers. Please help to resolve it.

My Cigna customer #is: [redacted].

The claim # in Cigna file is: [redacted]

Thank you very much for your help!

Sincerely,

[redacted]Desired Settlement: They can send [redacted] the amount immediately, or send me the amount of $130.17 so that I can pay **.

Business

Response:

Cigna will be sending a response to the customer today in regard to Revdex.com complaint # [redacted].

Review: CIGNA uses stall tactics to delay payment of insurance claims. This is accomplished first by not making it possible to file a claim online. After forcing it's customers to use snail mail they wait 30 days to "process" despite the information being written on their own provided forms. There is nothing anyone in customer service can do to expedite the process until 30 days have passed. After the mandatory waiting month in order to move the claim from processing to payment I must call customer service and make an inquiry. Only then do the move the claim to payments. I am still waiting for claims I filed in July and August to be paid as further bills pile up. It's pathetic that I speed the process up a week by filing claims online. Even more so how nothing happens with it until after 30 days. Worse yet how if I don't call the claim never moves.Desired Settlement: In the year 2014 CIGNA customers have to be able to file a claim online. It's pathetic. It's criminal negligence. CIGNA needs to make online claim service available immediately. Second I want my claims paid to me now! Once I pay my healthcare provider my latest bill I will have nearly $2000 of claims to be paid back. I need my current claims paid faster and my future claims to not experience these delays.

Business

Response:

Hello,Thank you for this information. This account will be under review and an outreach will be made to the customer once review is complete. Thank you,Nicole

Review: For more than a year now, I have had phone conversation, call center dialogue and have sent written correspondence to CIGNA to correct their records regarding my children's medical services. Each time, CIGNA apologizes and corrects the error only for it to happen again. This issue is delaying payment to my children's medical provider ([redacted] - [redacted]). [redacted] is, in turn, halting medical services because of lack of payment. This is very uncomfortable and a risky position, I no longer want to put my children in. CIGNA's records have never been officially corrected even after I talked to various levels of management.Desired Settlement: There needs to be a complete and final resolution to this record keeping matter. In my business, as I don't complete objectives it cost money. The time I've spent repeating the same request, discussing the matter with various CIGNA management and correspondence has equate to a loss of personal revenue of $250.00.

Business

Response:

Cigna's review is complete and the customer was contacted via phone call.

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: the issue of compensation was not addressed.

Regards,

Business

Response:

Cigna has completed our review of this Revdex.com request a final resolution was sent to the customer today, February 12, 2014.

Review: This company has provided false information, Stating that to receive my short term disability all I needed was a diagnosis from the doctor. I have received the diagnosis from my doctor, I can provide this information if necessary. However, now the company clai** that is not what it said but said that I needed a range of motion check. The person I spoke with was named [redacted], who clai** he has nothing to do with approval directly. Including this they do not answer the phone calls when I call, out of ~30 phone calls I have received a call back ~three times. Im about to lose my health insurance I have worked 18 and half years for, along with my house, I cant provide food for my family let alone the stress I am under through all this. My son has extreme OCD and anxiety issues documented by a Psychiatrist, he is also under a lot of pressure and I am very worried about his well being, as well as my husband who requires ~15 pills a day just to survive, without my insurance I will not be able to afford his medications and he will most surely die. My job will not let me return to work without a full release, and if I go back now im afraid that I will seriously hurt myself as I have multiple spine conditions and may end up losing the ability to walk. I could really use some help getting this company to do what it right and, They paid me for one month then denied me. I cant stress this enough it is important to get my short term disability just so I can feed my family, and if I lose the insurance there will most certainly be health complications with my son and husband and even myself. If the paperwork is required I can show that my doctor SPECIFICALLY said that I can not work right now.Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like to stop getting the run around, I would like my short term disability, and I would like them to own up and do what is right and stop trying to avoid paying me, I do not approve of how close they are to completely destroying everything ive worked almost 19 years for. I am old and I fear for my own health as well as that of my family, and they do not understand this. I want this runaround to end now so I can sleep easy at night.

Business

Response:

February 3, 2014

Dear **. [redacted]:

We are writing in response to your correspondence dated January 30, 2014, regarding **. [redacted]’s claim for Short Term Disability (STD) benefits. She was covered under her employer provided, self - funded STD plan [redacted], which was administered by [redacted]).

In her letter, **. [redacted] expressed concern regarding [redacted]’s adverse determination for ongoing STD benefits and lack of communication during the handling of her claim. We appreciate the opportunity to explain [redacted]’s decision and address her concerns.

On November 11, 2013, we received **. [redacted]’s claim for STD benefits. Based on our initial review of her medical records, her claim was initially approved for the period of November 11, 2013 through December 4, 2013. For ongoing benefits to continue, we needed to assess how **. [redacted]’s ongoing medical condition impacted her ability to function, and whether it continued to prevent her ability to return to work. For this purpose, we followed up with her treating physician to monitor her progress.

On December 11, 2013, we received **. [redacted]’s medical records. The information received consisted of an office visit note dated December 4, 2013. This information was reviewed by a [redacted] Nurse Case Manager.

The review noted that the medical information did not provide sufficient details to measure the severity of **. [redacted]’s ongoing condition or how it was impacting her ability to function and perform her work duties beyond December 4, 2013. Specifically, there were no clinical or observed findings documented, other than her reports of back and knee pain, demonstrating a severe functional impairment. Based on this information, and the review of her file as whole, we determined that the information provided did not substantiate an ongoing Disability beyond December 4, 2013, and her claim was closed.

Regarding the lack of communication, we would like to clarify our contact timeline. On November 13, 2013, we reached out to **. [redacted] to conduct the initial STD interview. However, we were unable to reach her. According to an automated message, her voice mail was not set up and we were unable to leave a message. On this same date we mailed out a letter acknowledging the receipt of her claim. On November 18, 2013, we reached out to **. [redacted] again. During the conversation she confirmed her treating physicians and we informed her that we would be requesting medical information on her behalf. On December 5, 2013, we received a voicemail from **. [redacted] indicating she would be off work until her next doctor’s appointment.

On this same day we returned **. [redacted]’s phone call and left her a message requesting a call back to discuss her claim. On December 10, 2013, we contacted **. [redacted] and notified her of the claim approval. We also informed her that to be eligible for ongoing benefits additional medical information would be requested on her behalf. On January 03, 2013, we reached out to inform her of our adverse determination for ongoing benefits. However, we were unable to reach her. On January 9, 2013, we successfully contacted **. [redacted] and informed her of our decision. In addition, we offered assistance with the appeal process.

Subsequent to our decision, on January 23, 2014, we received **. [redacted]’s request for an administrative appeal review. As part of the appeal process, we referred her file to the Disability Appeal Team and assigned it to Appeal Specialist (AS), [redacted]., for reconsideration. Upon the completion of the appeal review, and once a decision has been rendered, we will notify **. [redacted] directly of the outcome. We appreciate **. [redacted]’s continued understanding and cooperation as we consider her eligibility for, and entitlement to, ongoing benefits under her STD plan. Should she have any questions or concerns regarding the appeal process, she may contact her AS, [redacted]., at [redacted].

We appreciate the opportunity to be of service and hope that the information provided is helpful to you.

Should you have any further questions or concerns, please do not hesitate to contact our office.

Sincerely,

Review: CIGNA has failed to deliver the health insurance payment check of $9,621.00 to me as stated by its staff numerous times. Instead, CIGNA delivered the check to the medical provider. I have notified CIGNA numerous times that I paid $4,000.00 out of the $12,000.00 upfront for my surgery and therefore the insurance benefits check must be sent to me and not the medical provider. CIGNA has stated numerous times that it would send the check to me, but instead it sent the check to the medical provider. CIGNA is refusing to send me the payment because it is telling me that the medical provider already deposited the check. I request that CIGNA reissue the check to me.Desired Settlement: I request that CIGNA send a check for the amount of $9,621.00 to me as it originally agreed to.

Business

Response:

Cigna has completed our review of this Revdex.com request and a final written resolution will be sent to the customer today, December 20, 2013.

Review: It has come to my attention that Cigna determines any qualified claim that has been submitted beyond 180 days of service to be null and void.

This 180 days expiry of coverage for any service not submitted should be posted FRONT AND CENTER on every Explanation of Benefits document that Cigna publishes. Anything less is unethical - a simple and expedient way for Cigna to refuse coverage for nothing.

I became aware of this policy by chance when overhearing a colleague mention it.

After looking for information about this policy and not finding it anywhere in my coverage information or on the webiste or on any of my claim forms, I called in, today, November 8th and asked the customer service agent, [redacted] in [redacted] TN to find it for me. He knew of the policy, but could not find it in these locations either. He did finally find it. It is on side B of the Medical Claim Form under instructions. I then spoke to Jeff's supervisor, [redacted] in [redacted], PA. He agreed that the notice on side B of the claim form is the only location where this can be found. He suggested I go ahead and submit the claims and when they are denied, that I file an appeal stating I was unaware of the policy. Which I will do today. Hopefully that will resolve my most pressing concern of getting covered for the beneifts I subscribed to.

The bigger issue is the matter of CIGNA'S flagrant lack of PUBLICLY STATING IT'S POLICY on such a costly matter as expiration of benefits while still under coverage based on a policy THEY DO NOT PUBLISH. This must be put where it is ALWAYS FRONT AND CENTER for subscribers to see.Desired Settlement: I want full coverage for every service that I was covered for under my plan while I was covered. Period.

I also want someone to make Cigna accountable for intentionally misinforming their subscribers about loss of coverage based solely on information NOT provided on their webstie, on their coverage plan materials, on their Explanation of Benefits sheets AND ON THE FRONT OF THE CLAIM FORM IN BOLD LETTERS. Anything less is unethical - a simple and expedient way for Cigna to refuse coverage for their convenience only.

Business

Response:

A call was placed to the customer on 11-11-13 in regard to Revdex.com Complaint # [redacted] to discuss her concerns. We consider this complaint to be closed.

Review: Cancelled my insurance policy.

I tried cancelling my policy starting December 31st but the wait time exceeded my lunch hour so I had tried back on January 2nd and once again the wait time exceeded my lunch hour and I couldn't reach the that evening for personal matters. I then called them January 3rd and waited an hour and twenty minutes. I spoke to a customer representative and she told me the only way to have the payment stopped was by calling my bank. I did the stop payment that evening and paid $33 for that but it was processed Monday. Called them back on Tuesday the 7th and waited an hour and thirty minutes. I spoke to a customer representative and they told me my refund would be issued in 15 days. This has affected my rent in a huge way. I have no gas or grocery money because of this reason. And I asked to speak to a supervisor and they put me on hold and then my call was "disconnected". They didn't try to reach me back so I called another service number and they put me through to a different answering line that wasn't even responding to my touch dial numbers. I tried calling this morning the 8th and they said that they couldn't help since the system was on re-boot. I am so angry with them. Horrible customer service, the representatives were not helpful in any way.Desired Settlement: $246 for my payment and $33 for my bank stop payment fee.

Review: I took my two sons in to get dental work. Cigna faxed three pages describing their insurance coverage. The paperwork showed the type of dental work we had done was 100% covered. I then received a bill from the dentist stating Cigna only covered some of the dental work. I contacted Cigna, and was told the dentist should have called and checked with them. I told them they were the ones who faxed the documents stating we were 100% covered. The representative was rude, and stated I could fight it, but I would not win. This person was able to e-mail me a 32 page explanation of my coverage in less than five minutes. I then spoke to [redacted], Manager, who stated she would look into it. She never called me back. I faxed in the forms the dental company received from Cigna to [redacted]. I then received a letter stating my dispute was unfounded, and I was still going to have to pay the dentist. I attempted to contact someone in the dispute department twice, but have yet to hear from them. I feel if Cigna could e-mail me my coverage in less than five minutes, they could have given my dentist the correct forms stating my coverage. If I would have known then the exact amount I was going to have to pay, I would have not gotten the dental work done on my two children. I now am responsible for a $728.00 bill. My insurance is through Cigna [redacted] and my member number is [redacted]. The insurers name is [redacted].

Product_Or_Service: dental work

Order_Number: [redacted]

Account_Number: [redacted] DentistryDesired Settlement: Desired Settlement ID: Refund

I would like Cigna to pay 100% of the coverage, since they are the one's who sent the paperwork stating they would cover it. I also would like to see a change in their policy, where the correct customer coverage is sent to the dentist, so this problem does not continue to happen. I currently paid the dentist $728.00, and would like Cigna to refund me.

Business

Response:

Hello,

Thank you for bringing this complaint to our attention. I have outreached the customer and am currently researching the issue. Upon resolution, I will provide my findings directly to the customer.

Thanks,

Review: Cigna had given me a health reimbursement debit card. I had 1500 dollars deposit in it. As per arrangement with my employer( [redacted]) . In lieu [redacted] was deducting premium from my salary. I joined [redacted] . but As I changed employer but Cigna continued as my health Insurance company. I had called and asked if I can continue using my debit card and was told that I can as long as there is money .There was 1500 deposit in it.

I saw their website www.mycigna.com which showed my insurance details as it is .And my debit card was still active. But now I am getting a notice from Cigna that I have to pay all the money which had been spent from the debit card. I am calling them but they are putting me on hold for hours and getting fed up I am unable to hold for hours.

Me and my new employer are paying thousands to cigna every month but their behavior and conduct is very bad and unacceptable.Desired Settlement: I need cigna to allow me to use the debit card (health reimbursement card ) till deposit is there as it is my money , I am spending.

Business

Response:

A written response was sent to the customer today surrounding Revdex.com complaint # [redacted]. They should receive the response within 5 business days.

Review: To whom this may concern;

I have been having serious back problems for the past year. I have been seeing a Spinal Reconstruction Surgeon. I have had multiple MRI's, X-rays,a discogram, spine injections, and done several months of physical therapy. I am in constant terrible pain for the past 5 or 6 months I have been going to a pain dr. My medication keeps getting raised to a higher milligram or I am able to take the medication more frequently. Because of this constant pain it has ultimately effected every aspect of my life. I am only 27 years old and have trouble walking and standing. Also because of this pain I have missed a lot of work at a job that I love so much and am afraid I may loose if I don't have surgery soon.

My Doctor had scheduled a spine fusion for my L4 L5S1 back in June. We sent in the pre-approval request to cigna. After several weeks of waiting I received a letter that stated my surgery was not medically necessary due to :" The documentation submitted does not confirm that there is a radiographic evidence od a grade! spondylolisthesis or segmental instability or grade 2 or higher spondylolisthesis."

: "The documentation submitted does not confirm that a central, lateral recess, or foraminal stenosis has been demonstrated on imaging studies."

: "The documentation submitted does not confirm that you are a non-smoker or will refrain from smoking or tobacco use for at least 6 weeks prior to the planned surgery."

After my doctor and I received this letter Dr. [redacted] scheduled a peer to peer with cigna. Dr [redacted] was able to explain to the Doctor from cigna the first 2 reasons the surgery was denied had been proved and all the info had been sent to the insurance company with all my other information. The Doctor from cigna then stated that because I was a smoker the surgery was not medically necessary. My doctor nor I had any idea that being a smoker could be reason to be denied a necessary surgery.

I tried calling and talking to customer service but the lady told me she would not explain to me what would happen if my request was denied in the peer to peer. She would not explain why being a smoker meant having a spine surgery( that would help ease my pain and allow my to get back to living a normal life), being denied as not medically necessary.

The insurance lady at the doctors office advised me that I was only the second person to ever be denied for this reason. She stated that the other person denied also had similar circumstances and was also insured through cigna. So I quit smoking. I willingly will give up anything if it means I can have my surgery. So we waited to resubmit for a pre approval. I took a blood test to prove to cigna I had no nicotine in my blood. The doctors office submitted all the paper and the blood test. We had rescheduled my surgery for August 22,2013. I received a letter on August 5,2013 from cigna stating they had received our request and were processing it as a GRIEVANCE. The letter then stated they had 30 calendar days from the day of submission (July 31st) to reply with a decision. The letter also says they will also notify me if they need more time to consider my request.

After all of this I received a call today from my doctor's office regarding the letter for a grievance. The customer service rep told my doctors office that because I had not responded to the letter that I received on August 5, 2013 that the process was being held up. The letter clearly stated that I DID NOT need to call Cigna if Dr. [redacted] has permission to file the grievance for me.The letter states " IMPORTANT: If you authorize this party to represent you in making this grievance, you do not need to respond." Later in the letter it states, " If you do not authorize this party to request of the grievance of the coverage decision for you, please notify us at [redacted] within five business days." Of course I approved my doctor to file this so I did not call the listed number. However when [redacted] from my doctor's office called to inquire about the status she was advised that the hold up on a decision was due to me not calling in to state it was ok for Dr. [redacted] to appeal my case. This is ridiculous.

Cigna is stalling and is causing more and more pain and distress. I am afraid that because of all the pain medication I have been on and I have to continue taking because I cant get my surgery, I will do permanent damage to my liver or become addicted to these pills. I started off on vicodin and now I'm on the middle range of oxycodone. I don't want to be on pills forever. I want to be happy and healthy. I have done everything the insurance company wants. I honestly am not sure if I can bare this awful pain much longer. I feel like I'm going mentally crazy sometimes from how bad I hurt. I want my life back. I want help and answers. Please help me get a answer from them.

Thank you for your time,

[redacted]Desired Settlement: I want cigna to stop stalling. I have already been dined a necessary medical procedure once and now I have jumped through all of their hoops and am not being talked to. My surgery is scheduled in 2 days and they are making this so much harder on myself. This is ridiculous. I pay my premium and I deserve to be treat with respect.

Business

Response:

Good day,

The matter has been resolved and the customer has been contacted.

Thank you.

Review: I was sent to collections because of a service provided by a nurse that was not approved by me. A nurse was a part of my C-Section that was not covered by Cigna but I had no option to deny this service. After talking to two representatives at Cigna they both agreed this bill was mislabelled and I should not have been chargesd. Neither of them would fix the problem just sent me to the appeals process which takes up to 30 days to be approved. I am in the middle of trying to purchase a home for me and my son and this bill is about to hit my credit. This is now jeopordizing the livelyhood of me and my family and was never suppose to happen in the first place. I have requested multiple times for this to be fixed with no response and have had to deal with slimy collectors trying to get me to pay for cignas mistakes. I have been with cigna for over 10 years and am now feeling like I am being punished for being a loyal paying customer. I am beyond disappointed with what has happened thus far.Desired Settlement: Please adjust my bill and remove this from collections

Business

Response:

Hello-Thank you for forwarding this complaint. Cigna will review this complaint and follow-up directly with the customer. Thank you.[redacted]

Review: 05/27/14, Two Cigna Dental Customer Service Representatives advised my Dentist Receptionist, [redacted] of the fact that my dental surgery would be covered 100%. [redacted] called two times on the same day 05/27/14, and verifed this fact. I, called Cigna Dental four times on 05/27/14, and four different Cigna Rep's advised me also that my dental surgery on 05/28/14 would be covered 100% by Cigna Dental. Unfortunately, and unprofessionally Cignal Dental reps want to take back what they said, now Cigna Dental is stating that Cigna Dental Reps made a mistake it was a error for the Cignal Dental reps to advise [redacted] at my dentist office that the surgery was covered. Now that Cignal Dental made a error Cignal Dental wants me to make up for the error by by $430.36 of the surgery. I had a scheduled appeal for 09/19/14, with Cigna Dental I called and re-scheduled the appeal date, for 09/25/14, because I called and re-scheduled the appeal date Cigna Dental Appeals committee punished me by denying my appeal three committee members punished me they were, Nancy C[redacted] Dania T[redacted] and Sharon F[redacted], talking about adding insult to injury. Cigna Dental has been extremely, unfair, and unprofessional with me considering the fact that Cigna Dental Reps made a error Cigna Dental should write this debt of $430.36 off because Cigna made a mistake Cigna wants me to clear up the mess, I am going to file a complaint with Arizona Department of Insurance also, I am also going to write to the Governor of Arizona regarding Cigna Dental unprofessional careless behavior I am positvie I cannot get a fair appeal with Cigna Cigna is looking for a excuse to make me pay for Cigna error.

05/27/14, A Customer Service Rep from my dentist office, **. [redacted], telephoned Cigna to confirm how much money Cigna would pay towards [redacted]'s dental surgery scheduled for 05/28/14 [redacted], telephoned Cigna two times on 05/27/14, each time [redacted] spoke with a different Cigna Rep and two times [redacted] got the same exact answer, Cigna Rep's advised [redacted] Cigna would pay 100% of [redacted]'s dental surgery [redacted] advised both Cigna Rep's of the total cost of the surgery. 05/27/14, the patient, [redacted] telephoned Cigna four times to verify the fact that Cigna Dental would pay 100% of her dental surgery on 05/28/14, The four times [redacted] telephoned Cigna [redacted] spoke with four different Cigna Rep's on all four telephone calls Cigna Rep's advised [redacted] Cigna would pay 100% of [redacted]'s dental surgery three months later Cigna states they will only pay 50% of the Dental Surgery because the information all six Cigna Rep 's gave was incorrect on 05/27/14, this is negligence on the part of Cigna unjust unfair [redacted] has filed a official complaint against Cigna with Arizona Insurance Commissioner also.Desired Settlement: Cigna Dental should pay for the error Cigna created, Cigna should pay the $430.36

Six different Cigna Rep's on six different telephone calls advised [redacted]'s dental surgery would be paid 100%, Cigna three months later in August 2014 states we made a mistake six different times on 05/27/14, we will pay only 50% Cigna should pay 100% of this surgery, this is what I feel is a just resolution, if Cigna refuses this shows unjust, unfair negligence on the part of Cigna, I have reported Cigna to Arizona Insurance Commissioner also, 100% of this surgery should be paid.

Business

Response:

Please be advised that we did not receive a Release of Information from the customer to provide the resolution to the Revdex.com. However, this complaint has been resolved and a resolution will be sent to the customer. Thanks you.

Review: Last year we spent $5163.15 in qualified medical expenses even though our maximum out-of-pocket is $5000. We have followed-up with Cigna around 10 times since the beginning of the year and Cigna refuses to correct the problem. We originally spoke with their customer service on 2/1/14 0915 MST, confirming each HSA charge with the representative. She suggested we write a letter to the Cigna Claims department itemizing the bills to show the overage and request a refund. We never heard back from Cigna, so called again on 2/21 1720 MST and spoke with Christina who committed to auditing our account by Monday to figure out why we were over-billed. We didn't hear back from her, so called in again 2/24 611pm MST and spoke with Anika. She said we needed to pursue ExpressScripts for the refund because they handle the prescription side of our health account. So we filed forms with ExpressScripts on 3/4 (which we received a response from on 4/8 saying all charges had been correctly applied to our maximum out-of-pocket and that the mistake was with Cigna). I spoke with Jennifer at Cigna on 3/10 230pm MST asking for a status update. She stated Christina was actively auditing our account. After not hearing anything yet again, I called on 4/12 and spoke with Jillian telling her that we were sick of the run-around and that, since there was no dispute that we'd paid $5163.15 in medical expenses in 2013, that Cigna just needed to refund our money and they could figure out their mistake on their own time. Jillian agreed and told us the problem was that $159.09 on 8/31/13 wasn't being counted toward our maximum out-of-pocket even though it should have been. So it took Cigna 2.5 months to figure out what the problem was, but at least we were expecting resolution soon. If only that were true. In our latest conversation in early May with Maria, Cigna is now telling us that the $159.09 didn't apply toward our maximum out-of-pocket because it wasn't a valid medical claim. When we pointed out that Cigna took money out of our HSA to pay that $159.09 claim, Maria told us Cigna was not responsible ensuring the payment is valid before taking it out of our account. She said auto-claim forwarding was a courtesy to us and that if they got the payment wrong that wasn't their problem. So our current situation is that Cigna owes us $163.15 and is refusing to give us a refund even though they are the ones that made the mistake.Desired Settlement: Prompt refund of $163.15. Also, Cigna management needs to fix this auto-claim forwarding and customer service training problem because I shouldn't have to deal with this again next year.

Business

Response:

A written response was sent to the customer on 08-01-14 in regard to Revdex.com complaint # [redacted].

Review: I went to [redacted] for in-network lab work. I do not have a co-pay for in-network lab work. I have tried multiple times since last August to resolve this issue with both [redacted] and Cigna. CIGNA covered it as an out-of-network claim when it is a in-network claim. I have probably made at least 10 phone calls either to CIGNA and [redacted] to resolve this. CIGNA keeps saying that [redacted] has to rebill it, that they used the wrong code. I have personally spoken to a person at [redacted] billing who put me on hold while she contacted CIGNA and told me the problem was resolved over a month ago. I again received a bill from [redacted] for $36.92 today. I called CIGNA again today to try to resolve it and I got disconnected and they gave me the same old story about how the hospital had to rebill again. I told them if it was not resolved with this phone call that I was reporting them to the Revdex.com. This is absolutely ridiculous that I have had to deal with this since last August. They paid $170.49 of a $207.41 bill.

The account # is [redacted]. The service was provided on 8/3/2012 and I have been trying to resolve it since then and all CIGNA does is give the the run around. They paid 80% as an out of network claim when it was an in network claim. I am done dealing with this.Desired Settlement: Pay $36.92 to [redacted] for the balance of the claim which is in network. Account # [redacted]

Business

Response:

Hello,

Cigna has received this complaint and is currently investigating. Acknowledgement has been sent to the customer under separate cover. Upon resolution, Cigna will contact the customer.

Thank you,