CIGNA

[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: The Cigna Executive Office Advocacy team sent a response letter that said they could not disclose any information pertaining to my complaints due to HIPAA law Protected Health Information(PHI) They said they did not have records of any complaints in the same letter Included were four more pages of release and HIPAA documentation to fill out This is simply a way to inconvenience the customer, hide behind a law that has nothing to do with their poor service and cause increased inconvenience to an already mistreated customer Customer service complaints, billing problems, claim inconsistencies and the outright misrepresentation of the facts is in know way related to HIPAA The insurance carrier is simply hiding behind a health information disclosure law to ignore the Revdex.com complaint and blame the customerSuch a response is unsatisfactory and does nothing to research or address the problems that this company denies all knowledge and responsibility for The response came from the Cigna, Executive Office, PO Box 188016, Chattanooga, TN The response was signed by a Kelly M*** Complaint tracking number they assigned was *** State of Tennessee East Account #*** No phone contact number was included and the HIPAA forms they requested are to be sent to another address in Scranton, PA
Very disappointed customer and clearly not important enough for Cigna to even acknowledge a complaint from Not sure if Cigna is a Revdex.com member but I sure hope they are held to a higher standard than the written letter which addressed nothing, denied knowledg and hid behind a health information law that had nothing to do with the complaint Again I find as the customer I am their lowest priority
Regards,*** ***

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 Illinois.Mr*** 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 decision.We 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 law.Since 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 benefits.Mr*** 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 claim.As 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 closed.As 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 attorney.To 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

[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. Thank you for your help in this matter
Regards,
*** ***

Revdex.com, Cigna, and *** *** ***:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. Without *** *** ***'s assistance I would have been constantly running in circles, being transferred between pharmacy and medical customer service. I would like to truly thank him for all his help in directing me to the correct team - Susie in your Fertility Team was truly a blessing and very helpful in reviewing my coverage with me and letting me know what I needed my doctor's office to do in order to utilize my benefits.Thank you again for all your assistance
Regards,
*** ***

[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 though no explanation or apology has been given, this resolution is satisfactory to me.
Regards, *** ***

Hello,
Thank you for this informationI will be in review of this issue and will contact the customer once resolvedThank you,
*** ***

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and resolution has been met with customer.Erica M***Executive Office Advocacy Team

On May 7, my daughter had a severe abdominal pain late in the evening so we took her to the nearest ER in I***, CAThe copay was $My daughter felt bad that I have to pay that money but I said it's okay all we need is to make sure you are alrightYesterday on 6/9/I received a bill of $from the radiologist they said my insurance decline to payI called my insurance last night, they asked if I have a second insurance I said NOI asked, where did you get this information? they didn't say anythingThe agent said I will clarify that and resubmit the claim and it's going to take business days in order to know if it was acceptedThis is frustrating the fact I have a very expensive insurance as a benefit from my employer where I pay around $400/Mo my self and I pay very high copay then esurprisingly paying additional billsMy daughter felt worse this time and she said next time she's not going to tell us about her health problem because she feels bad making us pay all the moneyThis made me more frustrated and sacred

------ Forwarded message ----------
sans-serif;">From: Revdex.com of Metro Washington DCDate: Fri, May 20, at 11:AMSubject: Fwd: complaint #***.To: ***
---------- Forwarded message ----------From: *** *** Date: Fri, May 20, at 11:AMSubject: complaint #***.To: ***This message is to inform you that, immediately after I have filed the complaint with Revdex.com, the Manager MrR*** from CIGNA called us and informed about CIGNA's intention to resolve the issue in favor of us
So request, you may please cancel or keep pending all further actions in this regard unless we contact you for further actions
Thanks
*** ***
*** *** ***

[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:
Regards,
*** ***

Dear Sir or Madam:We are writing in response to your correspondence dated August 5, 2013, referencing *** *** ***'s claim for Short Term Disability (STD) benefits*** *** was covered under her employer self-funded STD group benefit policy ***This plan was administered by *** *** *** ** *** *** (***).*** *** raised concerns regarding ***’s decision on her STD claim and her claim experienceCustomer service is extremely important to us and we have communicated this information to the appropriate management to be addressedPlease allow us this opportunity to address her concerns, explain our decision, and provide further administrative options.With respect to *** ***'s employer's, *** *** Retirement Systems, STD plan *** ***, in order for benefits to be payable, her medical records needed to support that her health conditions caused a functional impairment that would continuously prohibit her from performing the material duties of her regular occupationThe policy’s “Definition of Disability/Disabled” lays out these requirements and is defined on page of the enclosed plan.While her STD benefits were approved for a time, continued STD benefits were not payable to *** *** beyond July 20, 2015, because she no longer met the policy’s definition of DisabilityThis determination was based on our ongoing medical review of the relatively findings received from her treating providerAfter a complete medical review of the available records on file, it was determined that MsDe Marco’s condition would not render her Disabled beyond the date referenced above, according to the terms of her STD planAs a result, no further benefits were payable and her claim was closedOn August 4, 2015, a letter was sent to *** ***, which explained our decision and provided information that may be helpful to perfect her claim.We understand that *** *** disagrees with our decision of her STD claimIn conjunction with reviewing her claim, on August 10, 2015, attempted to contact her to offer assistance in filing an appealUnfortunately, the attempt was unsuccessfulIf there is any additional information that we have not considered, she does have the opportunity to request an administrative appeal reviewThe August 4, letter explains how *** *** can request an appealWe are fully committed to conducting full and fair reviews of all claims, and will consider any additional information she wishes to provideShould *** *** choose to pursue an appeal, she may also contact Senior Claim Manager, Joanna S., directly at #.*** ext*** for further assistance,Thank you for allowing us this opportunity to respond to your inquiry regarding *** ***'s STD claimWe 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 AdvocacyAttn: Meredith *L***North Norterra DrivePhoenix, AZ ***Sincerely,Rick P.Consumer Advocacy Specialist

Hello, Thank you for this inquiry. I have reached out to the customer to obtain further information, and will continue to do so until completion. Thank you, Kelly

[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: this is an UNBELIEVABLE lieAll my calls are recorded and transcribed and nobody called today or in the last week.I know their number, but you can be on hold waiting for an hour
Regards,
*** ***

We have tried to contact the customer, *** ***, using the telephone number listed in the complaint without successThis is not a valid numberThe person that filed the Revdex.com complaint will need to call ###-###-#### for resolutionWe consider this to be a closed issue

Hello- Thank you for forwarding this complaintCigna will be reviewing the complaint and will folldirectly with the customer. Tanya H***Executive Office Advocacy Team

This will acknowledge receipt of your correspondence dated June 16, 2015, regarding the above captioned matter.Please be assured that we will respond to your inquiry as soon as the necessary research is completed, but no later than the due date provided in your letterIf our research or response
efforts are delayed for any reason,we will notify you in writing.Meanwhile, should you have any questions, please contact me directly at ###-###-####Sincerely,Rick P*** Consumer Advocacy Specialist

Thank you for sharing this customer's complaintCigna will review the customer's account and folldirectly with the customer Thank youTanya H***Cigna Executive Office Advocacy Team

I received your correspondence on April 15, regarding complaint ID *** from *** ***.I am a member of the Executive Office Advocacy team, which was established by Cigna to respond to any customer who brings their concerns to the attention of the President and/or the Senior Management TeamI was asked to respond to this matter.This complaint was closed as unresolvedI would like this to be reconsideredI responded to the customer's initial request and rejection with written correspondenceI was able to respond directly on the Revdex.com (Revdex.com) website for the initial complaintThe rejected complaint did not have an option to respond on the websiteThe message that was posted is as follows:"There is nothing for you to do on this complaint right now."Under Health Insurance Portability and Accountability Act (HIPAA), Cigna HealthCare may not disclose Protected Health Information (PHI) under these circumstances without an authorization signed by the memberTherefore, if you wish to be advised of the outcome of our investigation, *** *** must complete the attached written authorizations and return them to me at the address on this letterhead.Please feel free to contact me at ###-###-#### if you have any questionsWe appreciate your assistance in protecting the privacy of our member's Protected Healthcare Information as mandated by law.Sincerely, Nicole P***Executive Office Advocacy Team

A Charlene from cigna corp office has contacted me she confirmed the facility is in network for cigna but the claims have yet to be correctedAs well They have done an internal audit and it shows we have been charged over our annual maximum deductible and that has not been corrected either

[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:
Very disappointed with *** *** *** response because it did not demonstrate any competence whatsoever in investigating this issueI almost seems that it was deliberately missed
This complaint specifically states that the procedure that I am talking about and being charged for is "Artificial Insemination" NOT EBRYO TRANSFER
** *** states in her letter that EMBRO TRANSFER is not coveredI know that! We paid out of pocket for it
I suggest ** *** re-read my complaint and seriously and competently investigate the claims of "Artificial Insemination" which under question here is a covered benefitThe amount I stated in the claim which I am being asked to pay does not correlate with EMBRO Transfer either
Again, I ask that *** *** STOP participating in the frustration and agony of coverage of this benefit and investigate this case open minded and not for the interest of CIGNA
If more information is needed I will be happy to provide it
Once again, very disappointed with the level of competence and ignorance shown in investigating this claim.Regards,*** ***