CIGNA

October 21, 2015
Dear Sir or Madam:
We are writing in response to your correspondence dated October 13, 2015, referencing [redacted]’s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer fully insured STD group benefit policy...

[redacted]. This policy was underwritten by [redacted] ([redacted]).[redacted] raised concerns regarding [redacted]’s overpayment amount related to her STD benefits. Please allow us this opportunity to address her concerns and provide a status update.
With respect to [redacted]’s STD benefit, our records indicate that she was initially paid through September 30, 2015. Upon further review of her benefit calculation it was determined that she had been overpaid in the amount of $1,342.42. In a letter dated September 30, 2015, our Overpayment Recovery Team (ORT) advised [redacted] of this amount.
We understand that [redacted] disagrees with our ORT request to repay this amount in full. In conjunction with reviewing her claim, on October 20, 2015, I attempted to contact [redacted] to address her concerns and provide an updated status of her request. Unfortunately, this attempt was unsuccessful. According to our review, on October 10, 2015, [redacted] and our ORT settled on an agreement, which would allow her to repay the complete overpayment amount in four separate monthly installments. Should [redacted] have any further questions related to her agreement, she may contact her Overpayment Recovery Specialist, Jim S., directly at [redacted] ext. [redacted] for further assistance.
Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted]’s STD claim. We hope the information provided is helpful. Should 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[redacted]Routing [redacted] P.O. Pittsburgh, Box [redacted]PA [redacted] Telephone: Facsimile: ###-###-#######-###-####[redacted]@cigna.com
[redacted] Phoenix, AZ [redacted] Email: [email protected] Fax: ###-###-####Sincerely,Rick P.
Consumer Advocacy Specialist

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution letter has been mailed to the customer on 03/10/2017.Charlene V[redacted]Executive Office Advocacy Team

Thank you for forwarding this complaint to Cigna. Cigna is currently reviewing the following complaint and when a resolution has been met I will outreach the member. Please see [redacted]achment for the customer. Erica M[redacted]Executive Office Advocacy Team

June
2, 2016Dear
[redacted],We are writing to respond to your
correspondence dated May 25, 2016, regarding [redacted]’s claim for Short Term
Disability (STD) benefits. As you’re aware, [redacted] was covered under her employer’s
self-funded STD plan [redacted], which was administered by [redacted] ([redacted]). Under [redacted]’s STD Plan, all requests for
an administrative appeal are handled by the [redacted]. ([redacted]). [redacted] is a privately owned peer review organization that
independently reviews appeals on behalf of [redacted]. Upon receipt of [redacted]’s
request for an appeal a referral was made to [redacted]. [redacted] does not know the
specific details of how [redacted] conducts their appeal reviews, but we are consulted
about their review. In response to your May 25, 2016
correspondence, we requested an update from [redacted] on the status of [redacted]’s
appeal. As of May 25, 2016, [redacted] has made the determination that the original
denial of STD benefits made by [redacted] should not be overturned. [redacted] is
responsible for sending out all communication regarding this decision, and if
[redacted] has not received a letter regarding their decision she should receive
one shortly. [redacted] should refer to this letter for any remaining appeal
rights she may have under her Employer’s Plan.Should
you have any questions or would like to discuss this matter further, please
feel free to contact me directly at ###-###-####.Sincerely,Eric F[redacted]Compliance
Specialist

January 6, 2016
Dear Sir or Madam:
We are writing in response to your correspondence received on December 29, 2015, referencing [redacted]' claim for Short Term Disability (STD) benefits. [redacted] was covered under his employer self-funded STD group benefit plan...

[redacted]. This plan was administered by [redacted] ([redacted]).[redacted] raised concerns regarding his most recent STD claim experience and customer service issues. Customer service is extremely important to us and we have communicated this information to the appropriate management to be addressed. Please allow us this opportunity to address his concerns, explain our decision, and provide an updated status of his claim.With respect to [redacted] employer's STD plan [redacted], 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. The policy's “Definition of Disability/Disabled” as:
The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:
1. unable to perform the material duties of his or her Regular Occupation, and
2. unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular Occupation.
While his STD benefits were approved for a time, continued STD benefits were not payable to [redacted] beyond November 30, 2015, because he no longer met the policy's definition of Disability. This determination was based on our ongoing medical review of the relatively stable findings and imaging reports received from his providers. After a complete medical review of the available records on file, it was determined that [redacted]' condition would not render him Disabled beyond the date referenced above, according to the terms of his STD plan. As a result, no further benefits were payable and his claim was closed. On December 11, 2015, a letter was sent to [redacted], which explained our decision and further explained the appeal process.
Subsequent to our decision, [redacted] requested that his Claim Manager request further medical documentation from his treating providers to be considered. Although this is not our standard process, on December 12 and December 15,2015, our claims department sent requests for updated information to [redacted]’ treating providers. Upon receiving this updated documentation and reviewing it with our medical experts, it was determined that [redacted] would be unable to perform the duties of his Regular Occupation and on January 5,2016, his STD benefits were reinstated,At this time, [redacted]’ STD claim remains active as he continues to be eligible for STD benefits. Should he have any questions regarding his STD claim status or payment he can contact his new Claim Manager, Andrew W., directly at ###-###-#### for further assistance.Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted]’ STD claim. We hope the information provided is helpful. Should 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[redacted]Phoenix, AZ [redacted]Email: [email protected]: ###-###-####Sincerely,Rick P.
Consumer Advocacy Specialist

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

[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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: because they will not even talk to me I want to be compensated for which they will not provide me
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 Administratively Resolved]
 Complaint:...

[redacted]
I am rejecting this response because:
This is not adequate.  When I use the system to get a quote and it shows a $40, I assume it would be $40.  Another doctor referred me to this doctor because they felt there was a valid reason for concern.  The paper I attached to the complaint show they filled out $40 and then crossed it off after the exam.  It is absolutely not right to be under the assumption that I will be paying $40, then at the end when there was no problem indicated saying it will be $210 is outrageous and should not be allowed especially since the $40 was in agreed in principal by marking down on the sheet and taking us back for the exam.  If we were quoted at $210 we would have considered other methods.  Furthermore this plan has [redacted] vision and when using the Estimate your cost tool for an Optometrist it shows the $40 copay as being valid for In Network doctors.  This resembles a bait and switch tactic, except we had no out since we did not know about the inflated cost until after the exam was complete and went to pay.
Regards,
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and several calls have been placed to the member for a call back to specify the complaint . No response. Still working on customers concerns.Erica M[redacted]Executive Office Advocacy Team

Good morning,I sent a written response to the customer in regard to his concerns earlier today. The response was sent out via email and regular mail. The claim for the customer was processed on 11-29-16 per the instructions on the electronic claim. This issue has been resolved.

Thank you for forwarding this complaint to Cigna. Cigna is reviewing the complaint, and an acknowledgement letter was sent to the customer on February 6, 2017.

Hello-Thank you for forwarding this customers complaint to Cigna. We will be reviewing this and will follow-up directly with the customer. Thank YouTanya H[redacted]Cigna's Exeuctive Office of Complaints

Hello,
 
THank you for this information. I have reached out to the customer to go over the options in regards to any premium reimbursement.  The customer has my direct phone number for any questions.
 
Thanks,
[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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
I do not need to sign a medical release for you to take responsibility and fix the collection incorrect billing problem. That's literally the only thing that needs to be done. You've sent multiple people to call me who don't have the authority to reverse the billing issue. Fix it. And tell me it's fixed. 
Regards,
[redacted]

Cigna has been in contact with the customer and a resolution has been reached for Revdex.com complaint # [redacted].

February 2, 2016
Dear Sir or Madam:
We are writing in response to your correspondence dated January 25, 2016, referencing [redacted] claim for Long Term Disability (LTD) benefits. [redacted] was covered under his employer's fully insured LTD group benefit policy [redacted]. This policy was underwritten by [redacted]) and sitused in the state of Massachusetts.
[redacted] raised concerns regarding his most recent LTD claim experience and claim decision. Please allow us this opportunity to address his concerns, explain our decision, and provide an updated status.
With respect to [redacted]'s employer's LTD policy [redacted], 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 occupation. The policy's "Definition of Disability/Disabled” lays out these requirements and is defined on page 2 of the enclosed policy.
While his LTD benefits were approved for a time, continued LTD benefits were not payable to [redacted] beyond November 27, 2015, because he no longer met the policy’s definition of Disability. This determination was based on our ongoing medical review of the relatively stable findings received from his providers. After a complete medical review of the available records on file, it was determined that [redacted]'s condition would not render him Disabled beyond the date referenced above, according to the terms of his LTD policy. As a result, no further benefits were payable and his claim was closed. On September 3, 2015, a letter was sent to [redacted], which explained our decision, provided information that may be helpful to perfect his claim and further explained the appeal process.
Subsequent to our decision, [redacted] requested an administrative appeal review of his LTD claim. As part of our process, his entire file was referred to an independent peer reviewer for evaluation.
For your reference, we have enclosed a copy of LINA's recent correspondence to [redacted], explaining that our prior decision on his claim was overturned on appeal. After reviewing updated medical

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and a resolution letter was sent to the customer on August 17, 2016.Rae B[redacted]Executive Office Advocacy Team

Hello,
Thank you for this information.
I have called the customer to verify he has received the documentation that was sent. I also have called the facility, as well, to verify the same information. Both have confirmed receipt. I have assured the customer this is the final review of the claim and will not reprocess.
 
Thank you,
Nicole P[redacted]

Good afternoon, Cigna's Executive Office of Complaints has received the complaint and will be following up with the customer directly for resolution. Thank You