CIGNA

March 24, 2017Dear *** ***,We are writing to respond to your correspondence dated March 16, 2017, regarding *** ***s claim for Short Term Disability (STD) benefits*** *** was covered under her employer provided, self-insured STD plan *** ***, which was administered by ***
*** *** ** *** *** ***). *** *** reported concerns regarding ***’s handling of her STD claim, and her customer service experienceCustomer service is extremely important to us and we have communicated this information to the appropriate management to be addressedWe appreciate the opportunity to address her concerns and provide a further update on the status of her STD claim.Based on our initial review of the information on file, *** *** went out of work on January 10, due to her conditionShe was approved for STD coverage through February 21, As detailed in our letter sent to *** *** dated February 21, 2017, we had been notified that her employer would be able to accommodate the restrictions put in place by her provider, and therefore her claim was closed with no additional benefits payableIf *** *** was unable to return to work as anticipated due to a continued disability, additional information would be needed to support her ongoing disability.On February 24, 2017, *** *** called in and spoke with our claims team, advising that due to her ongoing condition she was unable to return to work as anticipatedWe therefore requested updated information from her treating provider to determine if an ongoing disability was supportedFaxes were sent to her provider dated February 28, 2017, March 6, 2017, and March 10, Calls were also made to the treating provider on March 6, 2017, and March 15, to follon the status of our requestsOn March 15, 2017, we received a response from *** ***’s treating providerThis information was reviewed, and it was determined that *** ***’s claim would be extended for further STD benefits from February 21, through March 17, 2017.Our review shows *** ***’s treating provider did not respond to our requests for further information until March 15, Upon receipt, we were able to extend *** ***’s benefits through March 17, As of March 20, 2017, *** *** has provided contact information for two additional treating providersWe are currently in the process of requesting information from these providers to determine if her claim for STD benefits can be extended beyond March 17, We will continue to follow up for this information by fax and phone, and once this information is received, it will be reviewed to determine if this additional information would continue to support an ongoing disability that would allow for a further extension of STD benefits.Should you or *** *** 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

Additional time is needed to review this caseA letter requesting an extension was sent to the customer on March 7,

[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 ***, and find that this resolution is satisfactory to me. the payment check was finally written months an days after the service was performed which is late and unsatisfacrory service by cigna and they require reprimanding by the insurance authorities to prevent this kind of performance in the future to me and fellow clients.
Regards,
*** ***

Thank you for this informationI have reviewed the issue and a response was sent to the customer in writing on September 22, Thank you
Rae B***

May 14, Dear *** ***,This letter is in response to your inquiries regarding the above captioned matter on behalf of *** *** Life Insurance Company, a Cigna company (Cigna).*** Systems, LLC, ***), is the third party administrator representing
*** *** 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 both their explanation and final decisionIf you have any questions feel free to contact me-SrCompliance Associate

July 22, 2014Dear *** ***,This will acknowledge receipt of your letter dated July 8, regarding the above captioned matter, which was received in our office today.We have forwarded this matter to the appropriate area for research and response.Please be assured that you will
be contacted as soon as the accountable area has had an opportunity to conduct the necessary research in response to your inquiryWe will respond to your inquiry as soon as possible, but no later than ten business days from the date of this letterIf we believe our research or response efforts will require additional time to complete, we will let you know.Meanwhile, should you have any questions, please feel free to contact our office.Sincerely,Kristen D***

An electronic response was sent to the Revdex.com in regard to complaint # *** for *** *** on 06-27-A written response was also sent to the customer

Hello,Thank you for this information.A written response has been sent to the customer today, March 22, 2016.Thank you,Nicole P***

We have reviewed the concerns of the customer and have made the appropriate adjustment to the claim in question as an exception The customer/client has a dedicated line to call to handle any questions or concernsPlease direct the customer to (###-###-####)

[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 ***, and find that this resolution is satisfactory to me as far as returning the $ However, the money you charge for the services covered should be illegal and what Cigna advertises is false
Regards,
*** ***

October 20, 2016Dear *** ***We are writing to respond to your correspondence dated October 13, 2016, regarding *** ***’ claim for Short Term Disability & Long Term Disability (STD & LTD) benefits*** *** was covered under his employer provided, fully-insured STD policy ***
*** & LTD policy *** ***, which were underwritten by *** *** *** ** *** *** (***) and issued in Tennessee.*** *** indicated in his correspondence to you that he had concerns regarding the evaluation of his STD and LTD claimsThank you for the opportunity to respond to *** ***’ inquiry, explain our process, and provide an update on the status of his STD & LTD claims.Based on our initial review of the information on file, *** *** stopped working as of April 7, due to his conditionIn order to be eligible for and entitled to benefits under Asurion’s STD and LTD group policies, *** *** was required to meet his policies provisions, including the definition of Disability and Pre-Existing Condition Limitation described as:For STD policy *** ***:Definition of Disability/Disabled The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is: unable to perform the material duties of his or her Regular Occupation; and unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular Occupation.The Insurance Company will require proof of earnings and continued Disability.Pre-Existing Condition Limitation The Insurance Company will not pay benefits for any period of Disability caused or contributed to by, or resulting from, a Pre-existing ConditionA "Pre-existing Condition" means any Injury or Sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic measures, took prescribed drugs or medicines, or for which a reasonable person would have consulted a Physician within months before his or her most recent effective date of insurance.The Pre-existing Condition Limitation will apply to any added benefits or increases in benefitsThis limitation will not apply to a period of Disability that begins after an Employee is covered for at least months after his or her most recent effective date of insurance, or the effective date of any added or increased benefits.For LTD policy *** ***:Definition of Disability/Disabled The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is: unable to perform the material duties of his or her Regular Occupation; and unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation.After Disability Benefits have been payable for months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is: unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and unable to earn 80% or more of his or her Indexed Earnings.The Insurance Company will require proof of earnings and continued Disability.Pre-Existing Condition Limitation The Insurance Company will not pay benefits for any period of Disability caused or contributed to by, or resulting from, a Pre-existing ConditionA "Pre-existing Condition" means any Injury or Sickness for which the Employee incurred expenses, received medical treatment, care or services including diagnostic measures, took prescribed drugs or medicines, or for which a reasonable person would have consulted a Physician within months before his or her most recent effective date of insurance.The Pre-existing Condition Limitation will apply to any added benefits or increases in benefitsThis limitation will not apply to a period of Disability that begins after an Employee is covered for at least months after his or her most recent effective date of insurance, or the effective date of any added or increased benefits.On April 22, 2016, we sent *** *** a letter notifying him that because his effective date of coverage under the STD policy was March 1, 2016, and his date of disability was April 7, 2016, we would need to determine if the condition for which he was claiming disability was pre-existing in order to evaluate his eligibility for STD benefitsWe reviewed the medical information submitted by his providers, and determined that *** *** was not subject to a Pre-Existing Condition Limitation, and met the definition of Disability per his STD Disability policyHis claim was approved and our letter dated April 27, 2016, explained that payment of future benefits would depend on confirmation of his continuing disability status.Over the next several months, additional information was requested and obtained by our claim manager to support his continued Disability and eligibility for ongoing STD benefits*** *** was notified of these extensions in our letters dated May 13, 2016, and September 26, Ongoing STD benefits could not be approved until the information requested from *** ***’ treating providers was obtained in order to determine if he continued to meet the definition of Disability under the STD policyOur September 26, 2016 letter sent to *** *** outlined our determination that benefits would be approved through October 5, 2016, the maximum benefit period for his STD benefits under the policy.*** ***’ claim transitioned to our Long Term Disability (LTD) team on October 5, 2016, where a review was conducted to determine if *** *** was eligible for benefits under his Employer’s LTD policyThis review was necessary because the provisions of the LTD policy differ from those that govern his STD policyAs part of the review process to determine *** ***’ eligibility for LTD benefits, we sent a letter dated October 11, 2016, notifying him that we would conduct a separate evaluation to determine if the condition for which he was claiming disability was pre-existing, as outlined in the terms of the LTD policyWe obtained information from *** ***’ providers, including records that had not been obtained by our STD team during their reviewAs of October 18, 2016, it was determined that *** *** would be subject to a Pre-Existing Condition Limitation under his LTD policy, based on the information obtained, and LTD benefits were deniedA letter has been sent to *** *** dated October 18, 2016, detailing our determination and the appeal options available to him at this timeOur claim manager also called *** *** and notified him of our decision by telephone that same day.We understand that *** *** is concerned regarding the time taken to evaluate his STD and LTD claimsWe are committed to completing full and fair reviews on all claims, and we needed information from his providers to determine his eligibility for STD and LTD benefitsThe claim decisions were made based on the medical facts in his file, and according to the provisions in his STD and LTD policiesI spoke with *** *** on October 14, and October 19, 2016, and offered whatever continuing assistance I can provideAt this time, *** *** can submit his request for an administrative appeal reviewShould he have further questions about the decision that was made or about filing an appeal, he may contact his claim manager Martin Fat ###-###-#### extension ***.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

Cigna Dental is very misleadingOn my first visit I had some basic restorative done and they covered none of it because I was day shy of the month waiting period I was not aware of the waiting period as it was buried deep inside the policy information, had I known I would, of course had waited another day or two to go to the dentist So I ended up paying the entire bill myself Then a month later I returned for a cleaning and they only paid about dollars of my dollar bill, apparently my chosen dentist was not on their preferred list, which when I searched their site for a provider it made me believe he was in their network and that my cleaning would be 100% covered I appealed the decisions on both but that was just a formality I believe to keep me quiet for a month or so, but in the end both were still denied If you need dental insurance look at another company and consider just putting the premium into a saving account and use it as you need it, you will come out better that way

[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: ***
I am rejecting this response because: Miss Erica- did finally forward the information I requestedMiss Erica would not provide me with this information when I verbally asked 2-timesUntil I posted the claim in this Revdex.com complaint she did not complyI will go over all the info provided and decide then if I am satisfiedLike I said I requested this into a longtime ago and she stated she didn't have to provide it to me.Regards,
*** ***

Thank
you for bringing this to our attention the issue has been discussed and
resolved directly with the customer

[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 ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Complaint: ***
I am rejecting this response because: as of right now, all it says is a
written response is being sent to the customerI want to know what that response is before I determine if I am satisfied
Regards,
*** ***

[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: ***
I am rejecting this response because: Cigna fails to follow up with meThis has been on going since February and every time a supervisor tells me they will "get back" to me in a couple of days I never hear back from themAt this time I have been waiting almost week for a supervisor to call me and when I called on 7-15-to speak with her to follow up on my end I was told by a representative they would request a call back and as of 7-20-I have heard nothing from them
Regards,
*** ***

---------- Forwarded message ----------From: Revdex.com of Metro Washington DC Date: Mon, Nov 17,
at 9:AMSubject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #***.To: *** *** ---------- Forwarded message ----------From: *** *** Date: Sat, Nov 15, at 7:PMSubject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #***.To: "[email protected]" I am so sorry to write to you again I do not have any answers or Cigna has not contact me at allWhat do I need to do next?thank you--------------------------------------------

[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 ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and resolution letter has been sent to the customer on 09/16/2016.Charlene V***Executive Office Advocacy Team