CIGNA

[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,
*** ***

on March 30, I have spoken to the customer and informed him, I have left several voicemail message for *** at ***
HospitalI was calling to confirm they have received our EFT payment on 03/15/I have also requested for confirmation of when payment will be issued to the customerI have made another attempt to reach *** on April 04, and again had to leave a voicemail message to return my call. Pamela D***Executive Office

February 28, 2017Dear *** ***,Thank you for your patienceI’ve finished my review of the
issue you brought to our attention regarding the denial of a replacement crown.On behalf of Cigna, I sincerely apologize for the inconvenience and
frustration you have experiencedI’d like to share with you the steps I took
to investigate this matterI
have been in contact with the dental claim processing area in regards to
services that were rendered on July 11, in the amount of $I
have confirmed the claim was denied correctly based on your Dental
coverage through ***I
have been informed that *** has a five year replacement clause; your
crown does not meet the five year requirements as indicated in your plan
benefits.According to
our records, we made a final determination (decision) on your appealsWe
mailed a letter with the results of our decision on February 06, The
internal appeal review process is now exhaustedThis means that Cigna
won’t review this claim againPlease refer to this letter to see if you
have any external appeal optionsYou’re important
to us?Thank you again for sharing your concerns with the Executive Office at
Cigna.Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and resolution has been sent to the customerPamela D***Executrive Office Advocacy Team

Hello-A letter addressing this complaint was issued to the customer on September 14, If the customer wishes for the results of this review to be shared with the Revdex.com, the attached authorization form will need to be completed and returnedThank youTanya H***CignaExecutive
Office Advocacy Team

Please note that the customer's complaint is still in reviewUpon completion a response will be sent to *** ***Thank you

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

Hello-
Thank you for sharing this customer's concernsA formal follhas been mailed to the customer in response to this
Thank you
Tanya H***

[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: I cannot accept this response at this time because to date I have not received any correspondence from Cigna in writing regarding this matter
Regards,
*** ***

Cigna has addressed the customer's concerns with him This issue is considered closed

November 30, Dear Sir or Madam:We are writing in response to your correspondence dated November 19, referencing *** *** *** 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.*** *** raised concerns regarding his most recent LTD claim experience and customer service issuesCustomer 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 his concerns, explain our decision, and provide further administrative remedies available to him.With respect to *** ***'s employer's LTD policy ***, in order for benefits to be payable, 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 his own occupation beyondThe policy's "Definition of Disability/Disabled” lays out these requirements and is defined on page of the enclosed policy.While his LTD benefits were approved for a time, continued LTD benefits were not payable to *** *** beyond October 20, 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 himDisabled 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 October 21, 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.In addition to the information above, *** *** raised questions regarding payment for medical recordsAccording to our review, on several occasions dating back to July 2015, *** requested updated medical records from *** ***'s providers to obtain medical documentation for review.Additionally, on August 4, 2015, our Claims Department mailed a letter notifying *** *** of the failed attempts to have updated records sent back from his physicians (copy enclosed)It is important to note that our request specifically mentioned how to submit an invoice for any medical billing:In order to help expedite the handling of your patient's claim, please fax this information to ***-***If necessary, you may also nail the requested information to the above address.If there is a fee for the medical records requested, please forward a bill including your Tax ID number with the return of the requested records.To ensure *** ***'s concerns are thoroughly addressed, I have also enclosed a copy of a request letter sent to his provider for updated recordsWe understand that *** *** disagrees with our decision of his LTD claim.On November 30, 2015, in conjunction with reviewing his concerns, I contacted *** *** directly to offer assistance in submitting an administrative appeal reviewDuring our discussion, *** *** agreed to allow our department to initiate an appeal review on his behalfAt this time, his claim has been referred to our appeals department for reconsideration of benefitsWe are fully committed to conducting full and fair reviews of all claims, and will consider any new information*** *** wishes to submitOnce all of the information he wants to provide has been collected and an appeal decision has been rendered, he will be contacted directly with the outcomeIn the meantime, should *** *** have any specific questions regarding the appeal process, he can contact Senior Appeal Specialist Katie H., directly at ###-###-#### for further assistance.Thank 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 Attin: Meredith *L*** *** *** *** Phoenix, AZ *** Email: [email protected] Fax: ###-###-####Sincerely,Rick PConsumer Advocacy Specialist

this issues has been completed on our endhowever, the customer request that Cigna not contact her. Pamela D***Executive Office Advocacy Team

We have reviewed the termination and resolved the payment grievance with you directly for back premiumsYour dental plan is reinstated with no gaps in coverage

Dear *** ***,We are writing to respond to your correspondence dated May 30, 2017, regarding** * ***’ claim for Short Term Disability (STD) benefitsAs you area aware *** *** was covered under her employer provided, self-insured STD plan *** *** which was administered by *** *** *** ** *** *** ***.Customer service is extremely important to us, and we regret any confusion that may have occurred regarding the contact between *** ***’ treating provider and medical staffAs noted in our previous response dated May 25, 2017, as of May 23, *** ***’ entire claim file, including the clarification received from her treating provider, was under review with our medical staffOn May 26, 2017, we completed our review and determined that *** ***’ claim would be approved*** *** was issued STD benefits from April 19, through May 22, We were notified that *** ***’ had been released to work as of May 23, 2017, and her claim was therefore closed.Thank you for allowing us this opportunity to respond to your inquiry regarding ** *** claimShould *** *** have further questions on the status of her claim, she may contact her claim manager, John C., at *** ***Should you 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

Cigns's
billing and enrollment department has discussed this issue with the customer
directly
Thank you
for bringing this to our attention

Cigna is
actively working with the customer toward resolution of this issue by phone and
correspondenceDetails will be given directly to the
customer
Thank you
for bringing this to our attention

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and an acknowledgement letter was sent on September 26, 2016, and a resolution letter has been sent to the customer on October 6, 2016.Rae B***Executive Office Advocacy Team

Hello-
Thank you for sending this complaint to CignaThis matter will be reviewed and Cigna will folldirectly with the customer
Thank youTanya H***

The customer's complaint is still under reviewUpon completion a response will be sent to ***Thank you

Hello-Cigna is in the process of reviewing this customer's complaint and will provide an update directly to the customerThank youTanya H***

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