CIGNA

We have been in contact with [redacted] in regard to her concerns. This case is being reviewed by our Provider Services Unit. This unit will be contacting [redacted] to discuss her concerns in detail.

April 28, 2015
Dear Sir or Madam:
We are writing in response to your correspondence dated April 21, 2015, regarding [redacted]’s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer provided, self- funded STD plan SHD [redacted], which was...

administered by [redacted] has brought to our attention her concerns regarding the delay of her STD claim and benefits. We appreciate the opportunity to address her concerns, and to provide the current status of her claim.
Our office received [redacted]’s claim on February 25, 2015, and after completing our initial eligibility and medical reviews, her claim was approved on March 24, 2015. Her benefits were released for the period of February 28, 2015 through March 21, 2015. STD benefits were extended on April 6, 2015 through April 7, 2015.
For benefits to continue beyond April 7, 2015, our office needed to determine [redacted]’s entitlement to continued benefits under the terms of her STD plan. Updated medical information was requested, and was received in our office on April 16 and April 17, 2015. [redacted]’s medical records were reviewed on April 22, 2015, and it was determined that STD benefits were payable through April 27, 2014. On April 27, 2015, STD benefits were released for the period of April 8, 2015 through April 27, 2015. STD benefits will continue as long as the requirements of [redacted]’s STD plan continue to be satisfied.
We regret any stress caused to [redacted] during the claim review process. Moving forward, we will ensure that she is kept informed regarding any possible delays. We would like to advise that although STD benefits are paid on a weekly basis, prior to those benefits being released, we must validate [redacted]’s continued disability status.
We appreciate the opportunity to be of service and hope that the information provided has been helpful. Should you have any further questions or concerns, please do not hesitate to contact our office.
Sincerely,
Bianca W[redacted]
Consumer Advocacy Specialist

Hello,
Thank you for this information.
I will research the issue and reach out the to the customer once complete.
Thank you,
Nicole P[redacted]

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

April 15, 2016Dear [redacted],We are writing to respond to your correspondence dated April 7, 2016, regarding [redacted]’s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer’s self-funded STD plan [redacted], which was administered by [redacted]...

[redacted] ([redacted]). Thank you for giving us the chance to respond to [redacted]’s concerns.We have spoken with and advised [redacted] on April 11, 2016, that if she disagrees with the claim decision that was made regarding her STD benefits, she still has the option to appeal as outlined in our determination letter dated March 29, 2016. We have confirmed that her formal appeal has been received by our office on April 14, 2016. Now that we have received her request for an appeal, her claim has been referred to our Appeals Team for reconsideration of benefits. Our Appeals Team will perform a separate, independent review of her entire claim file, including any additional information [redacted] wishes to submit, to determine if our previous decision should be overturned.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

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

A written acknowledgement was sent to the customer on July 1, 2014. An outreach call was made to the customer today, July 7, 2014, to discuss the outcome of the review.

[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. 
They mentioned in their response that they will come back to me.The case is not closed
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:
 
No effort was made on the part of Cigna to resolve the issue (I have received nothing from them and have had no communication from Cigna on this matter), poor communication on the part of Cigna regarding policy details prior to enrollment and their desire to take the premiums but provide little to no service is unacceptable.  I am considering terminating my business with Cigna.  I encourage others to consider my experience before signing up with Cigna Dental Insurance.Regards,[redacted]

Complaint: [redacted]
I am rejecting this response because:Please see attached signed Health Care Directive.
Regards,
[redacted]

[redacted]  [redacted]
[redacted]
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  Two customer service representatives had incorrectly told my wife that her plan covered medical equipment that it actually did not and subsequent customer service representatives denied the request without providing a reasonable explanation. The issue has finally been resolved and a reimbursement was issued. 
[redacted]
[redacted]

Hello-Thank you for forwarding this customers complaints. Cigna will review and follow-up directly with the customer. Tanya H[redacted]Cigna's Executive Office of Complaint

Please be advised that this case is still under review. Upon review a response will be sent to the customer.
Thanks.

We have sent a written response tot he customer today in regard to Revdex.com # [redacted].

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 the information.  I will have this claim reviewed and contact the customer with resolution.
Thank you,
[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]

February 2, 2016Dear 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] ([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 employers 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 [redacted]'s recent correspondence to [redacted], explaining that our prior decision on his claim was overturned on appeal. After reviewing updated medical information with an independent peer reviewer, it was agreed the information on file would support [redacted]'s inability to perform any occupation. At this time, his claim has been forwarded to the Director of the Claims Department for reinstatement. On January 28, 2016. [redacted] was advised of this outcome and process. Once this process is complete. [redacted]'s Claim Manager, Mark W. will contact him and advise of the retroactive benefit amount that is being released to him. In the meantime, should [redacted] require any additional information related to the claim decision or our process, he may also contact supervisor and Team Leader, Tom S[redacted] directly at ###-###-#### ext, [redacted] for further assistance.Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted]'s LTD claim. We hope the information provided is helpful. Due to the volume, the Supporting documentation has been mailed to your attention under a separate cover. 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] Phoenix, AZ [redacted] Email: [redacted]. City Fax: ###-###-####Sincerely,Rick P. Consumer Advocacy Specialist

[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. 
I received both refund checks as of Tuesday, February 10th and my husband now has his HSA card.
Regards,
[redacted]

Cigna often commits fraud. I was sent to a Cigna medical group for an MRI, I was told by my physicians office that that is where my insurance wanted me to go. I also received a phone call from Cigna Medical Group stating " Hi this is Jason from Cigna and I'm calling to schedule your MRI." I received a large bill that would have been avoided had f I'd gone to the facility I requested I would not have received this bill. When I contested my insurance not covering the bill they used another name for where I had the MRI done so that they wouldn't have to cover it. I provided the insurance with a copy of the bill and how I had requested to have the test somewhere else and how this is where Cigna sent me to have the test.