CIGNA

Thank you for this information I will be reaching out to the customer directly to have this issue addressed Thank you, Kelly

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me at this time Rae has been in contact with me and has agreed to work with me to clear up all the problems I am having with getting my son's insurance claims repaid Regards, [redacted]

Hello, Thank you for this informationI will be in review of the issue and will respond to customer once review is completeThank you, Nicole P [redacted]

[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] Complaint: [redacted] I am rejecting this response because: It sounds like they did not read the complaint or address their error stating I did not have a biometric screening. I have spent many hours on this issue , hearing many false promises and talking in circles. And now I'm told to jump through another hoop, so I'll fill out the form and send it in. Regards, [redacted] ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered] Complaint: [redacted] I am rejecting this response because: Why am I still not seeing a response about my medical and dental coverage? My dentist was only sent a portion of the bill and I also have two other bills that still need to be paidI also was told I cannot appeal the decision if I have no new medical records, which I do not! The medical records I have state I cannot work or perform my regular duties and that should be all you needI have never seen any of your doctors for my condition so how would they know anything about me? Regards, [redacted]

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: [redacted] still has not been able to have the implant done and it will be august before this can be doneTherefore cigna has not yet completed payment for this serviceI am requesting once again to keep my complaint open until cigna has paid for the implantThis should be completed by sept Thank you Regards, [redacted]

Cigna is reviewing this matter and will respond with additional information We take patient confidentiality seriouslyProtecting our customers’ personal health information is criticalSo much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individual’s private health information (PHI)Because this matter requires that we look into personal information, we need [redacted] to give us permission to share our findings with the Revdex.com [redacted] can grant this permission by signing the attached Authorization for Use and Disclosure formThank you for forwarding this complaint to CignaCigna has reviewed this complaint and resolution has been met with customer.Erica M***Executive Office Advocacy TeamOR:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: Regards, [redacted] ***

We have sent a response to the customer in regard to Revdex.com complaint # [redacted]

Hello- This complaint is being addressedThank you

May 15, 2015Dear [redacted] :We are writing in response to your correspondence dated May 4, 2015, regarding [redacted] ’s claim for Short Term Disability (STD) benefits [redacted] was covered under her employer provided, self-funded STD plan [redacted] , which was administered by [redacted] (***) [redacted] has expressed her concerns regarding the management of her claim and customer serviceWe appreciate the opportunity to address her concernsAs outlined in our previous letter dated April 28, 2015, [redacted] 's claim's claim was received on February 25, 2015, and benefits were initially approved on March 24, 2015, Ongoing STD benefits were approved after receiving updated medical information On April 2, from her treatment provider that included the following: • Family Medical Leave and Medical Request Form (MRF) dated March 31, 2015; • Office visit note dated March 17, 2015; and • Work/School Status Note Based on the review of the above medical information, STD benefits were extended and a benefit check was released on April 6, 2015, for the period of March 22, through April 7, Our office did receive duplicate medical records from [redacted] on April 6, 2015, except for a March 9, office visit noteOn April 16, 2015, our office received an office visit note dated April 7, 2015; however, it was incompleteTherefore, on April 17, 2015, we requested [redacted] 's medical records from April 7, to the present and the completion of a MRFOur office received the requested medical information on that day, and they were reviewed on April 22, It was at that time it was determined that [redacted] 's benefits were payable through April 27, However, our office received an email from her employer indicating that she returned to work on April 22, 2015, As a result, STD benefits were only payable through April 21, [redacted] 's final benefit check was released on April 27, for the period of April 8, to April 21, In addition, we regret any stress caused to [redacted] due to the lack of customer service and effective communication during the claim review processWe are committed to customer service, and agree that effective communication is very important, especially when dealing with one's livelihoodAlso, we understand that [redacted] would like to be compensated for stress, late fees, and past due billsHowever, her STI) plan does not provide for additional compensation outside of the Disability benefitIf she still has not received her STD benefit checks, she may contact our office to discuss possible alternative methods to receive benefit paymentsWe would like to advise that any alternative would have to be discussed and approved by her employer, We appreciate the opportunity to be of service and hope that the information provided has been helpfulShould you have any further questions or concerns, please do not hesitate to contact our office,Sincerely,Bianca W***Consumer Advocacy Specialist

I have contacted the customer in regard to the rejection of Revdex.com complaint # [redacted] The customer has been advised of our next steps

We have received the Revdex.com complaint from this customer and have sent out an acknowledgement letter as of todayI have attached a copy of the authorization for disclosure form that was also sent to the customer

Hello, This complaint has been received by Cigna's Executive Office of ComplaintsCigna will follow up with the customer directly for review Thank You, Rafael P [redacted]

April 15, 2016Dear [redacted] ,We are writing to respond to your correspondence dated April 7, 2016, regarding [redacted] ***’s claim for Short Term Disability (STD) benefits [redacted] was covered under her employer’s self-funded STD plan [redacted] , which was administered by [redacted] ** [redacted] (***)Thank you for giving us the chance to respond to [redacted] ***’s concerns.We have spoken with and advised [redacted] on April 11, 2016, that if she disagrees with the claim decision that was made regarding her STD benefits, she still has the option to appeal as outlined in our determination letter dated March 29, We have confirmed that her formal appeal has been received by our office on April 14, Now that we have received her request for an appeal, her claim has been referred to our Appeals Team for reconsideration of benefitsOur Appeals Team will perform a separate, independent review of her entire claim file, including any additional information [redacted] wishes to submit, to determine if our previous decision should be overturned.Should you have any questions or would like to discuss this matter further, please feel free to contact me directly at ###-###-####.Sincerely,Eric F.Compliance Specialist CGI Consumer Advocacy

Thank you for frorwarding this customers complaintWe will review and folldirectly with the customer Tanya H [redacted] Cigna's Executive Office Of Complaints

I file a claim with Cigna for services I did not get: between November 2013-January A previous dentist kept submitting claims; like they were treating my son, but were not I called Cigna Customer several times and informed them; we were not there and requested a reimbursement to the account Someone, in Cigna got tired of hearing my complaint and referred my complaint to Cigna legal department: without my knowledge or consent About two and half years later, Cigna stated: “…we can’t do nothing…there is a lock on your account…You need to contact our legal department...” So...legal department put a lock on my account Basically- I cannot get a refund Now, it been three years I requested this refund nor have the legal team responded to any business why they have my account My son, needs his account credited back; his case is very hard We switched dentist due to billing issues Basically, when I inquired about the bill, they refused to continue with treatment unless I agree with charges I did not agree with the charges So, even though they started the ortho They did not do any maintain them the whole time I was there Eventually, the wiring and braces started coming off However, I was still being charged I figure, Cigna would not credit me for this services because we were still "there"; meaning I came into the office several times to dispute the bill without treatment But after we left this Dentist; they continue to charge; even though we both understood I was leaving I continue to contact Cigna, and update them, and file several complaints about the bills from this dentist office Cigna stated: “…were are looking into it…” But the verdict came back with neutral results and no credit About a year later, I found a experienced dentist; who could take a class ortho case Treatment is good We have one year left I want the money to complete his ortho because like I stated he was not treated during the months (November-January) at a previous dentist Basically the other dentist filed charges I made Cigna well aware of this Cigna had three years to credit this but refused; giving me the address only of their legal team The problem with the legal team; they are allowing another Dentist to file fraud claims; they put a blockage on my account and they don't have my consent I feel the legal department is wrong The legal department is letting a business file claims I reported a dentist filing unnecessary claims Its Cigna problem if they have a dishonest provider Why lock my account? I also feel Cigna customer service should not have referred me to their legal team making without my consent, then make it necessary to contact them They know I want my money back So, what I am to do? Being forced to talk to lawyers It seems Cigna is making it complex for me to get a refund If Cigna asked if I wanted their legal The answer would of been: "Why? Its just a refund." According to the consumer protection laws; a customer should not be unable to use service, when their account is in a billing dispute or question The services were not rendered and an automatic credit should of been applied The dentist office of whom I filed the claim had three years to prove their case They did not The legal department is put a stoppage for the company that owes me the credit The legal department is also bias because they make me fell that when the company is ready to file any complaints they are going to act like it is okIt has been three years and no one disputed my complaint, so my account should of been credited What is hard about giving my son's credit back Two weeks ago, I sent a certified letter to Cigna's legal department asking why there is a lock on my account However, I have decided that I am tried of being bullied and am returning any correspondences I just don’t feel like I should have to talk with a lawyer

August 18, Dear [redacted] ***,This letter is in response to your inquiries regarding the above captioned matter on behalf of [redacted] Life Insurance Company, a Cigna company (“Cigna”)[redacted] , LLC, ( [redacted] ), is the third party administrator representing, [redacted] Life Insurance Company on the group insurance coverage for the above referenced policy.We have reviewed their findings relating to this matter and concur with their explanation related to the issues raised by [redacted] ***If you have any questions feel free to contact me directly.Sincerely,Kristen D***SrCompliance Associate

September 9, 2016Dear [redacted] ,We are writing to respond to your correspondence dated September 2, 2016, regarding [redacted] ’s claim for Short Term Disability (STD) benefits [redacted] was covered under her employer provided, fully-insured STD policy VDT [redacted] , which was underwritten by [redacted] (***) and issued in Pennsylvania[redacted] has raised concerns over her STD claim being deniedIn order for [redacted] to be approved for STD benefits, she must meet the policy’s definition of Disability/Disabled [redacted] would only be considered Disabled if she was determined to be unable to perform the material duties of her Regular Occupation [redacted] initially went out of work on March 29, Her STD claim was approved through July 1, 2016, and [redacted] was advised that further medical information was necessary in order for benefits to be extended beyond that dateAs of August 24, we had received a response and clarification from her treating provider [redacted] ’s entire claim file was reviewed, including medical records and restrictions and limitations from her treating providerBased on the information submitted and reviewed, it was determined that she would not be precluded from performing her own occupation beyond the July 1, date and her claim was deniedThere was a lack of clinical evidence provided to verify symptoms of a severity that would support her claim to extend STD benefits[redacted] notes that we requested she treat with a specific provider during our reviewWe have discussed this with the claim manager who managed [redacted] ’s STD claim [redacted] does not dictate treatment to the customer, and from what we have determined this was a miscommunication between the claim manager and [redacted] where our claim manager asked if [redacted] had treated with a provider she had been referred to, not that she was stating she needed to treat with this personWe apologize if there was any confusion about this specific topic.Concerns were raised about [redacted] ’s treating provider having to resend the same information times [redacted] also brings up a series of phone calls from August 17, between several members of our staff and [redacted] ’s providerWe regret that the communication between [redacted] ’s provider and our staff was not more productiveWe take such allegations very seriously and have brought these concerns up to the appropriate management to be addressedAfter the August 17, phone call [redacted] contacted our claim manager and stressed that she would not like the two staff members involved in the August 17, call active with her claim any longerWe have honored [redacted] ’s request and both staff members were advised to no longer work on [redacted] ’s claimWe hope that this change will help resolve any tensions that may have arisen as a result of these calls.Our claim manager has sent a letter dated August 24, 2016, outlining details of our decision and advising [redacted] of the appeal process in placeShould she have further questions how to file an appeal or on why the decision was made, she may reach her claim manager Emily at ###-###-#### extension [redacted] .Should you have any questions or would like to discuss this matter further, please feel free to contact me directly at ###-###-####.Sincerely,Eric FCompliance Specialist CGI Consumer Advocacy

October 6, Dear Sir or Madam: We are responding to a complaint filed by [redacted] , which we received on October 3, 2014, regarding her plan benefits and limitations.Our records show that [redacted] had coverage with Cigna/ [redacted] plan from September 1, through December 31, 2013.The CGUC/ [redacted] Sickness and Accident Plan Is a fully insured limited plan with limited benefit structureThe plan has accident benefits which consist of $1,maximum per occurrence, payable at 80% of eligible charges after a yearly deductible of $is satisfiedThs pian allows two occurrences per benefit plan year, injury must occur while covered under the plan and only charges within days of the accident are eligible for benefits.Upon review of [redacted] ’s complaint, we found that the claim in question, [redacted] , was received for processing on December 14,We were unable to complete the processing of this claim as additional information was needed to rule out work related Injury.The accident detail questionnaire was sent to [redacted] on January 2, [redacted] returned completed accident detail questionnaire on January 15, noting that this was not a work related injuryThe claims related to this accident were reconsidered on January 22, allowing plan benefits [redacted] 's claims were processed to her maximum per occurrence accident benefit for benefit plan yearNo additional benefits are due at this time.Enclosed you will find the Explanation of Benefits for the claims paid in relation to this accident.If you have any questions or concerns regarding this matter feel free to contact me at ###-###-####.Sincerely, Millie I Regulatory Compliance Analyst