CIGNA

Hello,
Thank you for this informationI will be in addtional review of this issue and will respond directly to the customerThank you,
Nicole P***

Dear Sir or Madam:We are writing in response to your correspondence dated June 16, 2015, referencing Mr***’s Short Term Disability (STD) and Long Term Disability (LTD) benefitsMr*** was covered under his employer's fully insured STD benefit LK ***He was also covered under his employer's fully insured LTD policy LK ***According to our review, both of these policies were underwritten by *** *** *** of North America (LINA) and sitused in the state of IllinoisMr*** raised additional concerns regarding LINA's decision on both his disability claimsThank you for allowing us this opportunity to address his concerns and explain our decisionWe acknowledge that Mr*** believes the payment of his premiums would guarantee him coverage under his STD and LTD policiesHowever, both his policies have certain requirements that all covered employees of *** ***, Incmust satisfy in order to collect disability benefitsSpecifically, in the case for Mr*** the Exclusion provision referenced below:
Exclusions:
The Insurance Company will not pay any Disability Benefits for a Disability that results directly from:
an Injury or Sickness for which the Employee is entitled to benefits from Workers' Compensation or occupational disease lawSince Mr*** continued to report in both his STD and LTD claims that he was disabled due to the work related injury, according to his employer's policy, he would have not been considered eligible for LTD benefitsMr*** also mentioned that there have been other employees covered under *** ***, Incpolicies with similar situations and have been awarded benefitsPlease allow us to ensure Mr*** that every claim filed under *** ***, Incpolicies is evaluated on their own merits and medical documentation specific to that employeeAlthough Mr*** believes he understands the details of his coworkers’ claims, there is no way of him knowing what specific information was available in other employees’ claim files and our response can only speak to his specific claimAs noted in our previous response, an error transpired on LINA’s part, in which Mr*** received LTD benefits totaling $436.00, resulting in an overpaymentIt is our responsibility to accurately manage all claims filed under policy LK *** and adhere to the terms selected by *** ***, IncBecause this was an internal error, our claims department agreed to waive collection of this overpayment amount and on March 4, 2015, his claim was closedAs part of our process, and in conjunction with reviewing Mr***’s concerns, I attempted to contact him directly to offer further explanation and assistanceOn July 1, 2015, I discussed with Mr*** the most recent adverse determination, his current administrative options, and advised that my formal review of his case would be reported to the Revdex.comOn July 2, 2015, I spoke with Mr*** regarding the misreporting of the Revdex.com and his attorney being contactedDuring this discussion, Mr*** confirmed that he misunderstood what information was being provided to the Revdex.com and believed they would be working with his attorneyTo ensure Mr*** fully understood the outcome of his STD and LTD claim, he and I also discussed what information would be helpful in reevaluating his eligibility for and entitlement to STD and LTD benefitsPrior to any benefits being paid, Mr*** was advised that LINA would need to receive the official denial letter from his Workers’ Compensation carrier, stating the reasons for denialAs explained to Mr***, we remain fully committed to conducting full and fair reviews of all claims, and would gladly assist him in any way possibleShould Mr*** and his attorney choose to provide any further documentation for review, they can always contact his Claim Manger or her supervisor directly at ###-###-####• Therese M., ext*** (Claim Manager)• Joshua T., ext.*** (Team Leader)
Thank you for allowing us this opportunity to respond to your inquiry regarding Mr***’s STD and LTD claimsWe hope the information provided is helpfulShould you have questions or would like to discuss this matter, please do not hesitate to contact me directly at ###-###-####You may also contact CGI’s Consumer Advocacy department regarding any group disability, life or accident concerns at:Cigna Consumer Advocacy
Attn: Meredith AL***
*** *** *** ***
Phoenix, AZ 85085-8201Email: *** Fax: ###-###-####
Sincerely,
Rick P*** Consumer Advocacy Specialist

Thank you for this informationWe will be in review of this issue and will contact the customer directlyThank you,
Nicole P***

[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,
*** ***

Cigna is reviewing this matter and will respond with additional informationWe 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 her to give us permission to share our findings with the Revdex.com. *** *** *** can grant this permission by signing the attached Authorization for Use and Disclosure formRae B***Executive Office Advocacy Team

Complaint: ***
I am rejecting this response because:------ Forwarded message ----------From: Revdex.com of Metro Washington DCDate: Mon, Aug 3, at 10:AMSubject: Fwd: Complaint #*** - CIGNA CorporationTo: *** *** ---------- Forwarded message ----------From: *** *** Date: Fri, Jul 31, at 9:PMSubject: Re: Complaint #*** - CIGNA CorporationTo: "[email protected]" Attn: *** *** I have not contacted you to say whether I am satisfied with the the resolution of this complaint because there has been no resolution. I have not heard from CIGNA other than a note saying they are investigating. I would like to believe this is true and not simply a stall tactic.*** *** Sent from my ***
Regards,
*** ***

Hello-
Cigna is reviewing this customer's complaint and will folldirectly with the customerIf the customer wishes to have the complaint resolution shared with the Revdex.com (Revdex.com) the ***ached Authorization for Disclosure of Protected Health Information form needs to be
filled out and returned to Cigna
Thank you
Tanya H***
Cigna
Executive Office of Complaints

Thank you for this inquiry. I will have a Cigna Group Insurance contact this customer right away to have his concerns addressed
Thank you,
Kelly M***

Thank you for sharing this customer's complaintCigna will review the complaint and folldirectly with the customer
Tanya H***
Cigna Executive Office of Complaints

Hello,Thank you for this information.I have been in contact with the customer and am working to research and resolve the issue.Thank you,Nicole

Thank you for this information.I will be in review of this issue and will respond to the customer.Thank you,Nicole P***

Cigna had called out to the provider to suggest that they call *** to request a Peer to Peer to go over the denial. Peer to Peer was done and the authorization under *** for CT scan with contrast has now been approved

[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 6/10/
Charlene V***
Executive Office Advocacy Team

We have sent a written response to the customer today in regard to Revdex.com Complaint # ***

Thank you for forwarding this complaint to CignaCigna will review this complaint and will follow up with the customer.Charlene V***Executive Office Advocacy Team

Thank you for your responseIn order for *** ***'s visit to have counted for the incentive year, it would have had to have been completed no later than 10/24/Therefore, the money is correctly applied to the 20oincentives

We have been in contact with the customer in regard to Revdex.com complaint # ***The customer has been advised of the next steps

Received:Mar 02, 08:42:AMFrom:V***, Charlene * ***To: Revdex.comSubject:Complaint #***Hi ***,Complaint #***, *** *** has been resolvedResolution letter along with check copies has been sent to the customer on March 1, 2017.Thank you,Charlene *V***

Good Morning,
This complaint was received by Cigna's Executive Office of ComplaintsWe will be following up directly with the customer for resolution
Thanks,
Rafael P