CIGNA

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

Hello-
Thank you for forwarding this claim to CignaWe we review this complaint and folldirectly with the customerTanya H***
Cigna
Executive Office of Complaints

Information requested

February 2, Dear Sir or Madam:
We are writing in response to your correspondence dated January 25, 2016, referencing *** *** *** claim for Long Term Disability (LTD) benefits*** *** was covered under his employer's fully insured LTD group benefit policy ***This
policy was underwritten by *** *** *** ** *** *** (***) and sitused in the state of Massachusetts.*** *** raised concerns regarding his most recent LTD claim experience and claim decisionPlease allow us this opportunity to address his concerns, explain our decision, and provide an updated statusWith respect to *** ***'s employers LTD policy ***, in order for benefits to be payable, as of November 27, 2015, his medical records needed to support that his health conditions caused a functional impairment that would continuously prohibit him from performing the material duties of any occupationThe policy’s “Definition of Disability/Disabled" lays out these requirements and is defined on page of the enclosed policyWhile his LTD benefits were approved for a time, continued LTD benefits were not payable to *** *** beyond November 27, 2015, because he no longer met the policy’s definition of DisabilityThis determination was based on our ongoing medical review of the relatively stable findings received from his providersAfter a complete medical review of the available records on file, it was determined that *** ***'s condition would not render him Disabled beyond the date referenced above, according to the terms of his LTD policyAs a result, no further benefits were payable and his claim was closedOn September 3, 2015, a letter was sent to *** ***, which explained our decision, provided information that may be helpful to perfect his claim and further explained the appeal process.Subsequent to our decision, *** *** requested an administrative appeal review of his LTD claimAs part of our process, his entire file was referred to an independent peer reviewer for evaluationFor your reference, we have enclosed a copy of ***'s recent correspondence to *** ***, explaining that our prior decision on his claim was overturned on appealAfter reviewing updated medical information with an independent peer reviewer, it was agreed the information on file would support *** ***'s inability to perform any occupationAt this time, his claim has been forwarded to the Director of the Claims Department for reinstatementOn January 28, *** *** was advised of this outcome and processOnce this process is complete*** ***'s Claim Manager, Mark Wwill contact him and advise of the retroactive benefit amount that is being released to himIn the meantime, should *** *** require any additional information related to the claim decision or our process, he may also contact supervisor and Team Leader, Tom S*** 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 helpfulDue to the volume, the Supporting documentation has been mailed to your attention under a separate coverShould 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 *L*** *** *** *** *** Phoenix, AZ *** Email: *** ** *** *** *** *** ***City Fax: ###-###-####
Sincerely,Rick P
Consumer Advocacy Specialist

[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,*** ***

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

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

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

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

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

[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, *** ***

[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,
*** ***

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 does not resolve
Pending the review of more documents
Regards,
*** ***

Thank you for this information.We will be in review of this issue and will contact the customer directly.Thank you,Nicole P***

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

[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,
*** ***

Hello-
Thank you for sharing this customer's responseCigna will contine to review and folldirectly with the customer with additional information
Tanya H***
Cigna Executive Office of Complaints

October 30, 2015Dear *** ***,We are writing in response to your follinquiry regarding *** ***’s Short Term Disability (STD) claim*** *** raised additional concerns regarding the overpayment on her STD claim, and that she felt pressured to make payment arrangementsWe have further reviewed *** ***’s situation and the concerns she has raised, and have waived the overpayment on her claimWe will notify *** *** directly, and that trust this will resolve this matter to her satisfactionShould you have any questions or would like to discuss this matter further, please feel free 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 ** L*** *** *** *** *** Phoenix, AZ *** Email: [email protected] Fax: ###-###-####Sincerely,Brenda WManager, CGI Consumer Advocacy