CIGNA

Cigna has reviewed this complaint and resolution letter has been sent to the customer on 12/01/from the third party and a second resolution letter was sent from Cigna on 12/16/2016.The customer has been added to the DO NOT mail or call list and will no longer receive unsolicited mail. Thanks,Chiffon Christin Chiffon B***Executive Office Advocacy Manager- Customer Satisfaction

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and resolution has been sent to customer.Charlene V***
Executive Office Advocacy Team

[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 as Answered]
Complaint: ***
I am rejecting this response because:
Now, after four months of "please wait" I got a call from Cigna that they have paid "an amount" but not the agreed upon amount. I have already paid the amount four of their representatives have said was MY responsibility ($231.67). It seems Cigna has been trying to wear me out the past four months plus--and now throw another punch by not paying the amount they said for months they would eventually pay. There is no way a claim should take July 5th to November 8th, over four months to process and pay-affecting people's credit and then pay an amount not agreed upon by four different Cigna representatives. This needs more investigation and needs to be fixed. My credit needs to be fixed. I have invested in 9+ hours on this melody of errors. Grade: F
Regards,
*** ***

Thank you for this information I will be in review of this issue and will respond to the customer directly. Thank youPamela D***

Hello, This complaint has been received by Cigna's Executive Office of ComplaintsCigna will follow up with the customer directly for review. Thank You, Rafael 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,
*** ***

Hello,
Thank you for this informationThis account will be under review and an outreach will be made to the customer once review is complete
Thank you,
Nicole

Hello,Thank you for this information.A resolution letter was mailed to the customer on July 6, A duplicate copy will be mailes today July 16, 2015.Thank you,Nicole P***

[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:There is no date or timeline for when Cigna will complete this review or to provide me the written responseWithout dates this is not a valuable response and I cannot accept itI cannot trust Cigna to complete this in a timely manner because of the way they've already handled these claimsTo me Cigna is using a delay tactic hoping that this complaint will expire and they won't have to deal with it or actually resolve the issues with the claimsAs far as I know they are planning to start a review in years, finish it in years, and send me a response in years.
There is no definition of what their written response would contain or how it would resolve the issuesWithout understanding how the final written response would resolve the complaint I don't consider this initial response acceptableThe written response could be anythingAs far as I know the written response could be an offer for carpet cleaning discountsA written response is inadequateIt is entirely 1-sided, after the fact, and provides no opportunity for me to respond to the validity of the response, or ask questions about the content of the responseI don't believe that the complexity of the multiple issues that are ongoing can be handled with a single response with no input from meCigna has shown by their handling of these very claims so far that left to their own devices, they are incapable of understanding issues or an acceptable resolution
I do not consider it acceptable for me to wait an unspecified amount of time to receive an undefined document that may or may not be of any use and then having no opportunity to discuss that document with CignaI've done that already, with very limited success.
Regards,
*** ***

May 15, 2015Dear *** ***:We are writing in response to your correspondence dated May 4, 2015, regarding *** ***’s claim for Short Term Disability (STD) benefits*** *** was covered under her employer provided, self-funded STD plan *** ***, which was administered by *** *** *** ** *** *** (***).*** *** has expressed her concerns regarding the management of her claim and customer serviceWe appreciate the opportunity to address her concerns.As outlined in our previous letter dated April 28, 2015, *** ***'s claim's claim was received on February 25, 2015, and benefits were initially approved on March 24, 2015, Ongoing STD benefits were approved after receiving updated medical information On April 2, from her treatment provider that included the following: • Family Medical Leave and Medical Request Form (MRF) dated March 31, 2015; • Office visit note dated March 17, 2015; and• Work/School Status NoteBased on the review of the above medical information, STD benefits were extended and a benefit check was released on April 6, 2015, for the period of March 22, through April 7, Our office did receive duplicate medical records from *** *** on April 6, 2015, except for a March 9, office visit note.On April 16, 2015, our office received an office visit note dated April 7, 2015; however, it was incompleteTherefore, on April 17, 2015, we requested *** ***'s medical records from April 7, to the present and the completion of a MRFOur office received the requested medical information on that day, and they were reviewed on April 22, It was at that time it was determined that *** ***'s benefits were payable through April 27, However, our office received an email from her employer indicating that she returned to work on April 22, 2015, As a result, STD benefits were only payable through April 21, *** ***'s final benefit check was released on April 27, for the period of April 8, to April 21, 2015.In addition, we regret any stress caused to *** *** due to the lack of customer service and effective communication during the claim review processWe are committed to customer service, and agree that effective communication is very important, especially when dealing with one's livelihood.Also, we understand that *** *** would like to be compensated for stress, late fees, and past due billsHowever, her STI) plan does not provide for additional compensation outside of the Disability benefitIf she still has not received her STD benefit checks, she may contact our office to discuss possible alternative methods to receive benefit paymentsWe would like to advise that any alternative would have to be discussed and approved by her employer,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***Consumer Advocacy Specialist

April 28, Dear *** ***:We are writing in response to your correspondence dated April 23, 2014, regarding *** *** ***’s claim for Long Term Disability (LTD) benefitsShe was covered under her employer provided, fully insured LTD policy VDT ***, which was underwritten
by *** *** *** ** *** *** (***)The policy was issued in Minnesota.In her letter, *** *** expressed concern regarding the handling of her LTD claim and requested a status updateCustomer service is very important to us and we will continue to endeavor to provide high quality serviceDue to strict privacy guidelines, we are unable to provide you with detailed information regarding *** ***’s claimHowever, we would like to clarify the policy terms that impacted her claim and address her concernWe received *** ***’s claim for LTD benefits on January 22, In order to determine if benefits were payable under the terms and provisions of her LTD policy VDT ***, it was necessary for us to conduct an eligibility and medical review of her fileThis included determining whether she satisfied her policy’s definition of DisabilityOn January and February 6, 2014, we reached out to *** *** without successBecause we were unable to reach her by phone, on February 6, 2014, we acknowledged the receipt of her claim in writing, and informed her of the policy’s requirements and what was needed to fully evaluate her claimOn February 7, 2014, *** *** returned our phone callDuring the phone conversation, we explained her policy provisions and informed her that to move forward with our review we needed updated medical information that we would request on her behalfAs part of the evaluation process, on February 17, 2014, we requested *** ***’s medical information to determine how her condition was impacting her ability to function and perform the duties of her Regular Occupation as defined in her policyOn February 19, 2014, we notified *** *** in writing of our request for medical information and listed all the physicians that were contactedBecause no information was received, on March 20, 2014, we notified *** *** in writing of this delayOn March 26, 2014, we received the requested medical records and the information was reviewed by ***’s medical specialists.The medical review noted that although she reported functional loss, there were no exam findings or validated functional deficits to correlate a restriction of no work or the level of physical impairment reportedIn an effort to better understand *** ***’s condition and how it was impacting her functionality, On April 11, 2014, we reached out to her treating physician by phoneBecause the information obtained did not provide additional details regarding *** ***’s condition, we were unable to substantiate her DisabilityBased on this information and the review of her claim as whole, we concluded that *** *** was not considered Disabled and on April 22, 2014, her claim was closedA detailed letter explaining our decision was mailed to her attention on this same day.We acknowledge that *** *** may disagree with our decision and she has the opportunity to request an administrative appeal reviewOur April 22, 2014, decision letter explains how she can appeal and outlines information that may be helpful to perfect her claimAdditionally, and as requested in her letter, we will provide a copy of her entire claim file, including documentation regarding her claim status for reviewIn the meantime, should she have any questions or concerns regarding the appeal process she may contact our office directly at ***.We appreciate the opportunity to be of service and hope that the information provided is helpful to youShould you have any further questions or concerns, please do not hesitate to contact our office.Sincerely,

Thank you for this informationThis issue has been resolved and the customer contacted on 12/29/Thank you,
Nicole P***

Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and a resolution letter has been mailed to the customer on 12/11/2017.Janelle G***Executive Office Advocacy Team

[A
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to methey
have contacted me and agree that their actions had no merit and have resolved to waive the fee they initially were incorrectly charging me I appreciate all the help from the Revdex.com in resolving this matter.
Regards,
*** *** ***

Dear *** ***,We are writing to respond to your correspondence dated May 16, 2017, regarding *** ***’ claim for Short Term Disability (STD) benefits*** *** was covered under her employer provided, self-insured STD plan *** ***, which was administered by *** *** *** **
*** *** ***.*** *** raised concerns regarding her STD claimBased on our initial review of the information on file, *** *** went out of work on April 12, due to her conditionIn order to be eligible for and entitled to STD benefits under *** *** *** *** *** *** ***, *** *** is required to continuously meet the plan’s provisions and its definition of Disability/DisabledAs part of our assessment, we requested updated medical information from *** ***’ treatment provider to assess how her condition impacted her ability to function and perform in her Regular Occupation.Although we have received information from *** ***’ treatment provider, further clarification was required in order to accurately determine *** ***’ functional ability, and whether or not she would qualify for benefits under the planOn May 8, we requested this clarification from *** ***’ providerAs of May 23, 2017, this information was received and is currently under review with our medical staffShould *** *** 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

Cigna has completed our review of this Revdex.com request a final resolution was sent to the customer on April 3,
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Complaint: [redacted]
I am rejecting this response because:
" -webkit-text-size-adjust: auto;">10/6/Update: I called Cigna again today and was told by a representative in member services (Darren) that Mya did call me back on October 2ndI informed him that I never received a call from herHe read off the phone number she supposedly called and it's not my phone numberDarren told me the extra $I'm being charged on my premium IS in fact for pediatric dental and it's required by lawSo my sales agent blatantly lied to meI am going to pay everything they say I need to pay so that I can have coverage for my colicky baby who really needs to see a doctor but I absolutely expect all of the issues I've had with Cigna to be rectifiedI am disputing the extra $Cigna wants to charge me on my monthly premiums10/23/Update: Alejandra from Cigna Billing called me about two weeks ago as a result of the dispute I faxed them and said she the solution they can provide is to cancel the Cigna account, keep the Marketplace account (she told me that it was never actually canceled), waive August's premium so that it's like I'm getting coverage as of 9/1/14, and transfer my September and October payments to the Marketplace accountShe said she would do all of this and get back to me in a few days and that there would be a $credit on the account for the two months of pediatric dental that I paid for that I don't needI told her that was acceptable to meShe did call back a few days later and said she completed everything and all of the issues are now resolvedI told her I am still wary that there will be issues so she gave me her phone number and extension (###-###-####, ext [redacted]) in case there were any problemsToday I received two different bills in the mail from CignaOne says I owe $and the other says I owe $1,(seriously? What a joke)I called the number Alejandra gave me and it went to the main lineI asked to be transferred to her and was told by the representative that they are not allowed to transfer callsThe representative absolutely refused to transfer me to AlejandraSowhy did she give me her extension knowing that one would ever transfer me to her? I was told that I have a past due balance because my payments haven't been applied correctly yetFunny, since Alejandra told me they had been applied correctly as part of her "resolving" my disputeI told the representative I just want to pay what I owe for November and then I want to cancel my policy as of December 1st because I am so tired of dealing with Cigna and their shady business practicesI proceeded to pay for November and was then told that I would have to contact the Marketplace to cancel my policy because Cigna can't do itI was transferred to the Marketplace and told them I want to cancel my policyWhat a surprise, the Marketplace representative told me I do not have an active policy with themMy Marketplace application was canceled back in SeptemberAlejandra had told me that the Marketplace account never got canceled so was she just blatantly lying or did she not even check with the Marketplace? Cigna has no problem taking my money, but where in the world is it going? Why is there so much miscommunication in this company? Does no one ever follow through with anything? Do I even have coverage for my sick newborn baby? I called Cigna back again and did a three way call with the Marketplace and it went around in circles for about twenty minutes with Zulika (the Cigna representative) saying that the Marketplace needs to find the active account and cancel it and the Marketplace representative saying that there is no active account so there's nothing to cancel and me crying with frustrationI want someone from Cigna to actually do what they say they're going to do FOR ONCE and fix the problems they've createdAnd then I want whatever policy is active (because as of right now I have no idea which policy is active) to be canceled as of December 1st. I want a supervisor to call me and tell me when this has all ACTUALLY BEEN COMPLETED and I want direct contact information for that supervisor
Regards,
[redacted]

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because: As of today, I still have not received my refund. Though in this chain [redacted] refers to [redacted] Children's Hospital as responsible for issuing me a refund of $227.07, please let the record show that she told me differently in our initial conversation – that she was sending ME a check for $373. It wasn't until the next day that she notified me that the check would actually be sent to the hospital, who would then pass it along to me. The number $227.07 is what I initially requested in my Revdex.com complaint, and I will happily accept it, but this miscommunication is yet another disappointment in this sad saga of customer (dis)service. 
Regards,
[redacted]

May 8, 2017Dear [redacted],We are writing in response to your correspondence dated April 27, 2017, regarding [redacted]'s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer provided, fully-insured STD policy [redacted], which was underwritten by [redacted]) and issued in Arizona.[redacted] raised concerns about [redacted]’s review of her STD claim and her claim experience. Customer service is extremely important to us and we have communicated this information to the appropriate management to be addressed. We appreciate the opportunity to address her concerns and provide an update on the current status of her claim.Based on our initial review of the information on file, [redacted] was approved for benefits from October 14, 2016 through December 25, 2016 as she sought treatment for her condition. As explained to [redacted] in our December 14, 2016 and February 22, 2017 letters, we would be required to continue to follow up for updated medical documentation in order to support her ongoing disability.In order to be eligible for and entitled to further STD benefits under [redacted]'s STD policy, [redacted] is required to continuously meet the policy’s provisions and its definition of Disability. As part of our ongoing assessment, we have requested updated medical information from [redacted]'s treatment providers in order to assess how her condition has continued to impact her ability to function and perform in her Regular Occupation.Our review shows that [redacted]'s STD claim is currently still active, and the responses from her treating medical providers are currently under review to determine if a further extension of STD benefits can occur beyond December 25, 2016. As soon as a determination has been made. [redacted] will be notified of the decision, and what options may be available to her at this time.We apologize for the delays that [redacted] has experienced during her claim review. In response to [redacted]'s inquiry, we and our Claims Team Leader attempted to reach her at the phone number on file on April 28, 2017 and May 2, 2017. but were unsuccessful and unable to leave a message. Should [redacted] have further questions on the current status of her claim and our ongoing review, she may feel free to reach our Claims Team Leader, Ben, at ###-###-#### 1910. In addition, should you or [redacted] have any questions or would like to discuss this matter further, please feel free to contact me directly at [redacted]Sincerely,Eric F.Compliance Specialist

Thank you for forwarding this complaint to Cigna. Cigna has reviewed the following complaint and...

submits the following resolution: On February 22, 2017, Cigna mailed the member a copy of Explanation of Benefits for the requested date of service November 24, 2014 and for services provided in the month of November. The member should receive the following documents within 7-10 business days.  An outreach was placed to the member via telephone and my direct contact information was provided for any additional questions. Erica * M[redacted]Executive Office Advocacy Team