CIGNA

Hello,Thank you for this information.I will be in review of the issue and will respond directly to the customer.Thank you,Nicole P[redacted]

FIRST THEY STOPPED THE CHECKS AT 21 1/2 MONTHS WHEN THE POLICY CLEARLY STATES THAT THE POLICY DEFINATION CHANGES FROM "OWN TO any after 24 months. ON AUG 18TH 2014 THEY DECIDED TO DO THAT AND ON 9/7/14 I FILED AN APPEAL. I GOT ONE EXCUSE AFTER ANOTHER UNTIL ON DEC 19TH 2014 I FOUND OUT THAT AN EMPLOYEE HAD TAKEN A LEAVE AND FOR 122 DAYS THE CLAIM HAD SET ON HER DESK. I BELIEVE THE LAWS AND REGULATIONS STATE THAT THEY HAVE 45 DAYS AND IN AN EMERGENCY SITUATION EVEN LESS.
DURING THIS TIME JOEY HAD NO INSURANCE OR CASH TO SEE ONE. WHEN THE PEER REVIEW WAS DONE (SEE ATTACHED) THEY FOUND HIM DISABLED AND PAID THE 2 1/2 OTHER MONTHS. SO THEY SENT A CHECK 12/28/14 AND ON JAN 6TH 2015 THEY SHUT IT BACK OFF. SO I FILED ANOTHER APPEAL. EVERY PEER REVIEW DOCTOR HAS STATED FROM THE FIRST DAY THAT HE IS NOT PHYSICALLY ABLE TO WORK.EVEN THOUGHT FROM THE FIRST TO LAST REPORTS HAVE "ACCIDENTALLY" BEEN LEFT OUT. WE HAVE NOT ONCE SAID THAT HE IS MENTALLY INCAPIBLE UNTIL THIS LAST REPORT. BUT WHEN THIS LAST PEER REVIEW WAS DONE ONCE AGAIN IT STATED THAT HE CAN NOT WORK DUE TO HEAVY MEDICATIONS AND A HAZZARD TO CO-WORKERS. AND HE CANT TAKE THE MEDS AND EVEN DRIVE TO WORK. BUT THE PSY DOCTOR ALSO FOUND HIM DISABLED. AND WHEN HE DID THEY ASK HIM TYO JUDGE AS TO WEATHER HE WAS IN OCT 2014. NO HE WASNT THEN. AND I DIDNT STATE THAT IN THE LETTER. I STATED THAT HE HAD NO RIGHT TO DO THAT FROM A TIME PERIOD WHEN THE CLAIM SET ON A DESK GETTING NOTHING DONE. AND IN THAT PEER REVIEW IN WHICH THE TIME FRAME DID COVER FURTHER PAYMENTS THERE WAS ALSO SOME REPORTS MISSING. IF THEY HAD ACTUALLY WORKED ON THIS AND SENT OUT REQUEST OR CALLED A DOCTOR OR TWO THEY COULD HAVE FOUND OUT. THIS WAS HANDLED IMPROPER FROM THE BEGINNING BECAUSE THEN THERE WERE 21 REQUEST SENT AND NOT ONE WAS RETURNED WITH ANSWERS SO INSTEAD OF CALLING OR DOING A FOLLOW UP THEY BASED A DECISION ON BLANK PAGES.
THE POLICY WAS PRESENTED TO US AS A BUY UP AND BETTER COVERAGE WHEN IT IS NOTHING OF THE KIND.
THEY STATED "UNTIL AGE 65 NO MATTER HOW HE BECOMES DISABLED" "OH MR. [redacted] THIS WILL HELP YOU PROVIDE FOR YOUR FAMILY IN A TIME WHEN YOU ARE UNABLE TO" IT NEVER STATED YEAH IF YOU LOOSER YOUR RETIREMENT AND SELL YOUR HAOUS AND LOOSE YOUR VEHICLE YOU WILL HAVE CHANGE IF YOU BEG PEOPLE. THEY LEFT THAT PART OUT. AND THEY NEVER SAID HEY WE CAN'T TAKE YOUR MONEY BECAUSE.... ALL PAYMENTS WERE ACCEPTED AND NEVER LATE.
SO THIS IS WHY I AM REFUSING THEIR OFFER. FOR 4 YEARS WE HAVE ARGUED AND FOR 4 YEARS EVERY DOCTOR STATES THAT HE CAN NOT PHYSICALLY WORK. AT ANY JOB REGARDLESS. HE IS CONSIDERED UNDER THE INFLUENCE IF HE DRIVES AND TAKES HIS MEDICATIONS AND IF HE DOESNT TAKE IT HE IS IN SO MUCH PAIN HE CANT TOLERATE IT.

[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.]
Better Business...

Bureau:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  the payment check was finally written 3 months an 2 days after the service was performed which is late and unsatisfacrory service by cigna and they require reprimanding by the insurance authorities to prevent this kind of performance in the future to me and fellow clients. 
Regards,
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution has been met with customer.
Charlene V[redacted]
Executive Office Advocacy Team

Dear [redacted],Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint regarding [redacted]’s concerns that her Cigna Home Delivery account had been compromised. I can confirm that a resolution letter was mailed to the customer on February 6, 2018.Rae B[redacted] | Operations Specialist | Executive Office Advocacy Team   Phone: ###-###-#### | Fax: [redacted]

Please be advised that we did not receive a Release of Information from the customer to provide the resolution to the Revdex.com. However, this complaint has been resolved and a resolution will be sent to the customer. Thanks you.

Hello-
Thank you for forwarding this customer's complaint. Cigna will review this customers complaint and provide written response to the customer.
Thank you
Tanya H[redacted]
Cigna's Executive Office of Complaints

The customer was contacted via phone call on May 1, 2014 and the customer confirmed resolution.

[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:The specialist who reviewed my complaint did not read it correctly. I was talking about the site being misleading and making me believe I can use my MRA fund for dental reimbursement. She responded about reviewing a phone call; that's not what I asked to be reviewed. I will add attachments of the misleading information on the website to make it clearer.
Regards,
[redacted]

We are writing in response to your correspondence dated August 30, 2017, regarding [redacted] claim for Short Term Disability (STD) benefits. [redacted] was covered under his employer provided self-funded group STD plan [redacted]. This plan was administered by Life Insurance Company of North...

America (LINA).[redacted] reported concerns regarding LINA’s decision on his STD claim. We appreciate the opportunity to address his concerns, explain our decision, and provide an update on the current status of his claim.Based on our initial review of the information on file, [redacted] was approved for benefits from April 3, 2017 through June 24, 2017, as he sought treatment for his condition. In order to determine if an ongoing functional loss was present, we were required to continue to follow up for updated medical documentation in order to support his ongoing disability.In order to be eligible for and entitled to STD benefits under the State Farm Automobile Insurance Company STD plan, [redacted] was required to continuously meet the plan’s provisions, including its definition of Disability.While [redacted]’s STD benefits were approved for a time, continued STD benefits were not payable to him beyond June 24, 2017, because he no longer met the plan’s definition of Disability. This determination was made based on our ongoing medical review of the available medical findings, and our determination that there were no supported deficits from his providers. After a complete medical review of the available records on file, it was determined that [redacted]’s condition did 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 August 8, 2017, we sent a letter to [redacted] advising of this outcome and his right to appeal.“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include [redacted], Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. © Cigna 2017September 11, 2017 Page 2On August 9, 2017, we received [redacted]’s request for an appeal of our previous determination. His entire claim file, including the additional information submitted in support of his claim, was referred to our appeals team for a separate and thorough review. Based on this review of the available information, the prior determination to deny benefits beyond June 24, 2017 was upheld. This determination was made because the available medical information did not document findings that were determined to support an ongoing functional impairment that would preclude [redacted] from being able to perform the essential functions of his own job. On August 29, 2017, we sent a letter to [redacted] detailing this decision. [redacted] was also notified that under his Employer’s STD plan, he had exhausted all available administrative appeals, and no further appeals would be considered.[redacted] indicated that several pieces of information contained in our letters dated August 8, 2017 and August 29, 2017 were not reflected in his provider’s records. We have reviewed the Behavioral Health Questionnaire and the provider’s records in question, and can confirm that our letter accurately reflects the content of those notes and [redacted]’s functionality.[redacted] also raised concerns regarding the way we interpreted his provider’s records, and our assessment of the frequency of this treatment. While we understand that [redacted] disagrees with this assessment, as outlined in our August 28, 2017 letter at this time he has exhausted his appeals and no further appeal will be considered. Our determination was that an explanation of his functionality and how it continued to prevent him from performing the essential functions of his own job beyond June 24, 2017 was not provided.Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted]’s STD claim. We hope the information provided is helpful. We have confirmed that our appeal specialist, Susan, spoke with [redacted] on August 30, 2017 and September 7, 2017, further discussing our decision. Should [redacted] have any questions or would like to discuss this matter further, he may please feel free to contact his appeal specialist, Susan at ###-###-####. Please also feel free to contact me directly at ###-###-####.

Dear Sir or Madam:We are writing in response to your correspondence dated August 5, 2013, referencing [redacted]'s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer self-funded STD group benefit policy [redacted]. This plan was administered by [redacted] ([redacted]).
[redacted] raised concerns regarding [redacted]’s decision on 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. Please allow us this opportunity to address her concerns, explain our decision, and provide further administrative options.
With respect to [redacted]'s employer's, [redacted] Retirement Systems, STD plan [redacted], in order for benefits to be payable, her medical records needed to support that her health conditions caused a functional impairment that would continuously prohibit her from performing the material duties of her regular occupation. The policy’s “Definition of Disability/Disabled” lays out these requirements and is defined on page 3 of the enclosed plan.
While her STD benefits were approved for a time, continued STD benefits were not payable to [redacted] beyond July 20, 2015, because she no longer met the policy’s definition of Disability. This determination was based on our ongoing medical review of the relatively normal findings received from her treating provider. After a complete medical review of the available records on file, it was determined that Ms. De Marco’s condition would not render her Disabled beyond the date referenced above, according to the terms of her STD plan. As a result, no further benefits were payable and her claim was closed. On August 4, 2015, a letter was sent to [redacted], which explained our decision and provided information that may be helpful to perfect her claim.
We understand that [redacted] disagrees with our decision of her STD claim. In conjunction with reviewing her claim, on August 10, 2015, attempted to contact her to offer assistance in filing an appeal. Unfortunately, the attempt was unsuccessful. If there is any additional information that we have not considered, she does have the opportunity to request an administrative appeal review. The August 4, 2013 letter explains how [redacted] can request an appeal. We are fully committed to conducting full and fair reviews of all claims, and will consider any additional information she wishes to provide. Should [redacted] choose to pursue an appeal, she may also contact Senior Claim Manager, Joanna 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 [redacted]. You may also contact CGI's Consumer Advocacy department regarding any group disability, life or accident concerns at:Cigna Consumer AdvocacyAttn: Meredith *. L[redacted]
25600 North Norterra Drive
Phoenix, AZ [redacted]
Sincerely,
Rick P.
Consumer Advocacy Specialist

[redacted]
[redacted]
[redacted]
[redacted] Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint # [redacted]. Spoke with customer to discuss concerns on 06/05/2017 and resolution has been met. Thank you, Charlene E. V[redacted]

----- Forwarded message...

----------From: Revdex.com of Metro Washington DC<[email protected]>Date: Wed, Feb 22, 2017 at 9:36 AMSubject: Fwd: Complaint # [redacted]- CIGNATo: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted] <[redacted].net>Date: Tue, Feb 21, 2017 at 7:41 PMSubject: Complaint # [redacted]- CIGNATo: [email protected]: [redacted] <[redacted].net>, "[redacted]" <[redacted].net>To: Revdex.com of Metro Washington DC & Eastern Pennsylvania[redacted], Operations Team[redacted],My wife did not respond to the request for a response because she had not been contacted by Cigna at that time.Shortly thereafter, she was contacted by upper management of the company who profusely apologized for their behavior. He confirmed that his employee did, in fact, run my wife's outdated debit card after she had been provided with the new card information. Furthermore, an erroneous email was sent to my wife stating her monthly payment had been successfully processed followed by another email shortly there after stating that the account was in arrears and a $50 payment would have to be made to reinstate  the policy.The $50 fee request was cancelled and the insurance policy remains in effect.I wish to personally thank everyone at the Revdex.com for their help in resolving this matter.Had the Cigna CSR and her supervisor, taken ownership of their mistake, this complaint would never have been necessary.Thanks again for the outstanding work you do.Sincerely,[redacted] & [redacted]Sent from my [redacted] Air

[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 received the letter from Cigna stating that my account is now current, but after checking Cigna's online payment portal their correction does not appear - even though the letter states the correction was applied over a month ago. So I am unable to verify that the account has truly been corrected. I have been told numerous times that the correction has been made only to receive another late notice and be forced to start all over again. So this complaint will remain open until I can verify.
Regards,
[redacted]

My company--F[redacted]Group- in Greenville,Ohio has Short Term Disability thru Cigna. I am on std leave for a torn rotator cuff, 2 labrum tears and other problems with my right shoulder. I had surgery on October 24 and I will be off 4 months. They make me renew my std every 10-12 days. This company is TERRIBLE to deal with. I have left numerous calls to my case worker and she has NEVER called me back. I would NEVER recommend them to anyone. They are totally RIDICULOUS!!!!!!!! They do nothing to try and resolve my problems.

Hello-
 
Thank you for your inquiry. This is being reviewed and an outreach will be made to the customer upon completion.
Thank you.

--------- Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Mon, Jul 13, 2015 at...

9:10 AMSubject: Fwd: FW: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].To: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted] <[redacted].com>Date: Sun, Jul 12, 2015 at 10:54 AMSubject: FW: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].To: "[email protected]" <[email protected]>Cc: [redacted] <[redacted].com>Cigna did correct their error and I did receive a refund. Please update the complaint file. I am satisfied.

Thank you for this Inquiry- this was received on 8/29/2014.  Resolution will be sent to the customer directly.
 
Thank you,
Nicole P[redacted]

Thank you for forwarding this customers complaint. Cigna will review and provide follow-up directly with the customer. Tanya H[redacted]CignaExecutive Office Advocacy Team

Thank you for this information. We will contact the customer directly.
 
Thank you,
[redacted]