CIGNA

Information requested

Hello-
Thank you for forwarding this complaintCigna will review the customers complaint and folldirectly with the customerTanya H***

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 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 form. Charlene V***Executive Office Advocacy Team

Hello-
Thank you for forwarding this customer's complaint to CignaCigna will research this customer's complaint and provide folldirectly with the customer
Thank you
Tanya H***
Cigna
Executive Office of Complaints

[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 business just stated they would contact me. No settlement no justification or explination of the error
I have not hear from them in writing or any other way.Regards,*** ***

Thank you for this informationI have outreached to the customer and will handle issue through completion Thank you. Rae B***

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and a resolution letter has been sent to the customer on September 1, 2016.Rae B***Executive Office Advocacy Team

Cigna is reviewing this matter and will respond with additional information. We take patient confidentiality seriously Protecting 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.comBrittany McMurry-Harrington can grant this permission by signing the attached Authorization for Use and Disclosure formAlicia G*** Executive Office Advocacy Team

Hello-
Thank you for the inquiryCigna will be reviewing and will folldirectly with the customerTanya H***

Thank you for this information.We will be in review of this issue and will contact the customer directly.Thank 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. I only wanted to add my appreciation for *** *** and her excellent customer service! she went above and beyond reaching out each time for each question and I do appreciate the effort!Regards,
*** ***

Received:Feb 10, 03:43:PMComplaint # ***, *** *** has been resolvedOutreach to customer to discuss resolution on 02/09/and follow up email sent on 2/10/to confirm resolution.Thank you,Charlene ** V***Executive Office Advocacy Team

[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,
*** ***

[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. I am waiting for the response to be in writing and received the credit.Regards, *** ***

TeCigna 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 him 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 form. Charlene V***
*** *** *** ***ll us why here

Thank you for bringing your concerns to the attention of the Executive Office at Cigna.To Whom It May Concern,I want to let you know that I received the inquiry about *** ***I am part of the Executive Office Advocacy TeamMy job is to look into the concerns Cigna customers, and their
representatives, bring to the attention of our president and senior leadership team.We take patient confidentiality seriously Protecting 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 your inquiry requires that I look into Ms***'s information, I need her to give me permission to share my findings with the Revdex.comMs*** can grant this permission by signing an Authorization for Use and Disclosure form.Next Steps I will reach out to Ms*** to let her know that I received your inquiry, that the Revdex.com would like a response and that I need permission to communicate with youI will also send the Authorization for Use and Disclosure form so she can sign itI have attached a copy to this letter too so you have an idea of what it looks likePlease know that I must receive this signed form from Ms*** in order to respond to youIf I do not receive a signed form, I will communicate only with her.Thank you again for sharing your concerns with the Executive Office at Cigna.Sincerely, Nicole P***Executive Office Advocacy Team

December 11, Dear Sir or Madam:
We are writing in response to your correspondence dated December 2, referencing *** *** ***'s claim for Long Term Disability (LTD) benefits*** *** was covered under his employer full-insured LTD group benefit policy ***This policy was underwritten by *** *** *** ** *** *** (***) and sitused in the state of Pennsylvania*** *** continues to raise concerns regarding his most recent LTD claimPlease allow us this opportunity to address his concerns and provide a current update of his claimWe understand that *** *** continues to debate what documentation was sent to him and what information he did not receiveUnfortunately, we can only report what information is reflected in our recordsOur previous response to your department dated November 30, 2015, explains in detail this documentationTo ensure *** ***s concerns are thoroughly addressed, and per his request, we have referred his claim to our appeals department for reconsideration of benefitsAs with all claims, we remain fully committed to conducting full and fair reviews, and will consider any and all information *** *** wishes to submitWe acknowledge that *** *** mentioned that he has not received a recent phone call from his previous Claim Manager (CM), Matt RPlease note, once his appeal was referred to our Appeals Department, *** *** was assigned an Appeal Specialist who will perform a completely separate review of his caseAfter discussing his concerns with our Appeals Department, we were advised that his case has been assigned to Appeal Specialist, Kristi S., who will be reaching out to *** *** and will explain the appeal processShould *** *** have any specific questions regarding the appeal processhe can contact Kristi directly at *** ext*** for further assistanceThank you for allowing us this opportunity to respond to your inquiry regarding *** ***'s LTD 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 CGIs Consumer Advocacy department regarding any group disability, life or accident concerns at:Cigna Consumer Advocacy
Attn: Meredith *L***
*** *** *** ***
Phoenix, AZ ***
Email: [email protected]: Fax: ###-###-####
Sincerely,Rick PConsumer 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 does not resolve
Pending the review of more documents
Regards,
*** ***

September 2, Dear *** ***:
We are writing in response to your correspondence dated August 25, 2015, regarding *** ***’s claim for Long Term Disability (LTD) benefits*** *** was covered under his employer provided, fully-insured LTD policy *** ***, which was
underwritten by *** *** *** ** *** *** (***), and issued in Delaware.*** *** has brought to our attention his concerns regarding our adverse decision for LTD benefitsWe appreciate the opportunity to address his concerns, and to provide his available remedyOur office received *** ***’s LTD claim on January 16, Prior to benefits being approved and payable under the terms and provisions of his LTD policy, it was necessary that we determine his eligibility for, and entitlement to benefitsOnce *** ***’s eligibility was cleared, medical information was requested from his treatment providers for the period of August 6, to the presentTo obtain a better understanding of *** ***’s conditions as a whole and their level of impact on his ability to function and return to work, his file was reviewed by a Nurse Case Manager (NCM) and a Medical Director (MD)Both the NCM and MD agreed that at the time of review, *** ***’s available medical information did not support his inability to return to workSpecifically, the restrictions and limitations that were provided by his orthopedic surgeon were not supported by his medical findingsAfter completing our review, including both medical reviews, it was concluded that *** *** was not considered disabled under the terms and provisions of his LTD policy, and his claim was closed with no benefits considered payableOn March 10, 2015, *** ***’s administrative appeal was received, and his file was forwarded to the Appeals Unit for further reviewOn appeal, medical information was requested from his providers for the period of February 1, to the presentIn addition, our MD completed a peer-to-peer outreach call to *** ***’s orthopedic surgeon to obtain further clarification on his functionalityBased on the review of *** ***’s medical records and the outcome of the peer-to-peer outreach, it was the recommendation of the MD that *** *** was not precluded from returning to work on a full-time basisAfter completing our review of *** ***’s claim as a whole, we were unable to amend the previous claim decision, and his claim remained closedWe understand he disagrees with our claim decision; however, because his policy’s definition of Disability is a functional definition, our review focused on his medical records and the opinions of his treatment providersDuring the review we looked at the correlating documentation within his medical records and how his conditions impacted his ability to function and perform his work duties*** *** has the opportunity to request a second, voluntary appealFor the specifics on how to appeal and for a detailed outline of information that may be helpful to perfect his claim, he can refer to our April 8, 2015, appeal decision letter.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***

Hello,
Thank you for forwarding this complaintCigna has received it and will review the complaint for further research/folland resolution with the customer
Thank you,
Rafael P***