CIGNA

Hello-Thank you for forwarding this complaint to Cigna. This complaint is being reviewed and Cigna will work directly with the customer. Tanya H[redacted]CignaExecutive Office of Complaint

Acknowledgement Letter along with Authorization for Disclosure of Protected Health Information form sent to customer on 01/20/2017. Pamela D[redacted]Executive Office

Cigna is reviewing this matter and will respond with additional information.  We take patient confidentiality seriously Protecting our customers’ personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect...

an individual’s private health information (PHI). Because this matter requires that we look into personal information, we need her to give us permission to share our findings with the Revdex.com. Vada S. Wilson can grant this permission by signing the attached Authorization for Use and Disclosure form.

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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:Cigna responded by letter stating, I was  never covered due to a dual policy.  Cigna told me I could take out an individual policy because of my maxed out primary insurance. Cigna accepted five payments and  rejected all of my claims. This is utterly ridiculous. I would not have went to the dentist if cigna would not have enrolled me in an individual plan. I had to pay a lump sum to my dentist. Cigna is a very unprofessional company that does not pay attention to detail. This is the most horrible customer service, to make a customer pay for a business's mistake.
 
Regards,
[redacted]

Hello,
This complaint has been received by Cigna's Executive Office Advocacy Team, and we will follow up with the customer for resolution.
 
Thank You,
 
Rafael P[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 received a call stating they were going to correct the issue through July... setting the rate to $488 through July and refunding me accordingly through then... which is not what was initially agreed to. In May I was still charged $520 which leads me to believe nothing happen.
Regards,
[redacted]

We have sent a written response to the customer in regard to Revdex.com Complaint # [redacted].

I have had several different medical and dental insurance companies over the years. My experiences with Cigna have by far been the worst. Actually, I don't recall having a negative experience with other insurance organizations. My experience with Cigna has been so bad that I think I would be better off without insurance.
Each time a person in my family visits a doctor or medical professional of any kind I receive multiple correspondences from Cigna. I am told that they have evidence that my family is covered by another health insurance policy - which is not the case. Nevertheless, I have to complete the form EVERY TIME. I also get a form that I have to complete which inquires about where the injury occurred. If it occurred on a commercial property then I have to provide that organization's insurance information to them. If these correspondences occurred on occasion I wouldn't be as annoyed, but they occur every time we use our insurance - even for routine check ups. For a family of five that has both medical and dental, this paperwork adds up.
The worst thing about Cigna though is their FSA system. They froze my FSA card because I protest having to print out the EOB that Cigna gives to me because they already have it in their system. Cigna claims that they cannot communicate across departments; because the people who work in their FSA department are not part of the medical/dental departments, they cannot access the EOBs. In essence I have to print the EOBs from the Cigna website then fax them back to Cigna.
More recently, they are saying that because my specific dentist's name is not on the itemized bill that they cannot unfreeze my account. The itemized bill has everything they need - Dental office information, itemized services, itemized list of debits and credits all necessary dates, etc., but because my specific dentist's name is not listed I cannot use my FSA money. The FSA transactions do not list the dentist's name -only the dental office. Yet, they say that the information on both much match. They do match - the itemized bill and the transactions in FSA both contain the same dental office information.

Cigna is reviewing this matter and will respond with additional information.  We take patient confidentiality seriouslyProtecting our customers’ personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we...

protect an individual’s private health information (PHI). Because this matter requires that we look into personal information, we need [redacted] to give us permission to share our findings with the Revdex.com. [redacted]  can grant this permission by signing the attached Authorization for Use and Disclosure form. Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution has been met with customer.Erica M[redacted]Executive Office Advocacy TeamOR:

November 30, 2015
Dear Sir or Madam:
We are writing in response to your correspondence dated November 19, 2015 referencing [redacted] claim for Long Term Disability (LTD) benefits. [redacted] was covered under his employer full-insured LTD group benefit policy [redacted]. This...

policy was underwritten by [redacted]) and sitused in the state of Pennsylvania.[redacted] raised concerns regarding his most recent LTD 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 further administrative remedies available to him.
With respect to [redacted]'s employer's LTD policy [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 beyond. The policy's "Definition of Disability/Disabled” lays out these requirements and is defined on page 5 of the enclosed policy.
While his LTD benefits were approved for a time, continued LTD benefits were not payable to [redacted] beyond October 20, 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 October 21, 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.
In addition to the information above, [redacted] raised questions regarding payment for medical records. According to our review, on several occasions dating back to July 2015, [redacted] requested updated medical records from [redacted]'s providers to obtain medical documentation for review.
Additionally, on August 4, 2015, our Claims Department mailed a letter notifying [redacted] 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 [redacted]-[redacted]. 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 [redacted]'s concerns are thoroughly addressed, I have also enclosed a copy of a request letter sent to his provider for updated records. We understand that [redacted] disagrees with our decision of his LTD claim.
On November 30, 2015, in conjunction with reviewing his concerns, I contacted [redacted] directly to offer assistance in submitting an administrative appeal review. During our discussion, [redacted] agreed to allow our department to initiate an appeal review on his behalf. At this time, his claim has been referred to our appeals department for reconsideration of benefits. We are fully committed to conducting full and fair reviews of all claims, and will consider any new information. [redacted] wishes to submit. Once 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 outcome. In the meantime, should [redacted] 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 [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
Attin: Meredith *. L[redacted]
[redacted]
Phoenix, AZ [redacted]
Email: [email protected] Fax: ###-###-####
Sincerely,
Rick P.
Consumer Advocacy Specialist

Hello,
Thank you for notifying CIgna of this complaint. We will be following up with the customer directly.
Thank you,
Nicole P[redacted]

Hello-
Thank you for forwarding this complaint. Cigna will be reviewing the complaint and will follow-up directly with the customer.
Thank you
Tanya H[redacted]
 Executive Office Advocacy Team

Hello-
Thank you for sending this complaint to us. Cigna will review this customers complaint and follow-up directly with the customer.
Thank you.
Tanya H[redacted]

September 9, 2016Dear [redacted],We are writing to respond to your correspondence dated September 2, 2016, regarding [redacted]’s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer provided, fully-insured STD policy VDT [redacted], which was underwritten by...

[redacted] ([redacted]) and issued in Pennsylvania.[redacted] has raised concerns over her STD claim being denied. In order for [redacted] to be approved for STD benefits, she must meet the policy’s definition of Disability/Disabled. [redacted] would only be considered Disabled if she was determined to be unable to perform the material duties of her Regular Occupation. [redacted] initially went out of work on March 29, 2016. Her STD claim was approved through July 1, 2016, and [redacted] was advised that further medical information was necessary in order for benefits to be extended beyond that date. As of August 24, 2016 we had received a response and clarification from her treating provider. [redacted]’s entire claim file was reviewed, including medical records and restrictions and limitations from her treating provider. Based on the information submitted and reviewed, it was determined that she would not be precluded from performing her own occupation beyond the July 1, 2016 date and her claim was denied. There was a lack of clinical evidence provided to verify symptoms of a severity that would support her claim to extend STD benefits.[redacted] notes that we requested she treat with a specific provider during our review. We have discussed this with the claim manager who managed [redacted]’s STD claim. [redacted] does not dictate treatment to the customer, and from what we have determined this was a miscommunication between the claim manager and [redacted] where our claim manager asked if [redacted] had treated with a provider she had been referred to, not that she was stating she needed to treat with this person. We apologize if there was any confusion about this specific topic.Concerns were raised about [redacted]’s treating provider having to resend the same information 4 times. [redacted] also brings up a series of phone calls from August 17, 2016 between several members of our staff and [redacted]’s provider. We regret that the communication between [redacted]’s provider and our staff was not more productive. We take such allegations very seriously and have brought these concerns up to the appropriate management to be addressed. After the August 17, 2016 phone call [redacted] contacted our claim manager and stressed that she would not like the two staff members involved in the August 17, 2016 call active with her claim any longer. We have honored [redacted]’s request and both staff members were advised to no longer work on [redacted]’s claim. We hope that this change will help resolve any tensions that may have arisen as a result of these calls.Our claim manager has sent a letter dated August 24, 2016, outlining details of our decision and advising [redacted] of the appeal process in place. Should she have further questions how to file an appeal or on why the decision was made, she may reach her claim manager Emily at ###-###-#### extension [redacted].Should you have any questions or would like to discuss this matter further, please feel free to contact me directly at ###-###-####.Sincerely,Eric FCompliance Specialist CGI Consumer Advocacy

Complaint: [redacted]
I am rejecting this response because:----- Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Tue, Mar 21, 2017 at 2:14 PMSubject: Fwd: complaint #[redacted]To: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted] <[redacted].com>Date: Tue, Mar 21, 2017 at 2:06 PMSubject: complaint #[redacted]To: [email protected] reject business response. Please reopen case.[redacted]

We have responded to [redacted] by phone today with a resolution for Revdex.com # [redacted].

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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: I left a voice mail for the lady who called me!!! How hard is it, to read my letter and do what I ask? Are these cigna people stupid??? This will remain open until they do what I ask!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!...⇄ /> Regards,
[redacted] Sr

Hello-
Thank you for sharing this customer's complaint. I apologize for any confusion. Cigna will review the claim situation in question and will follow-up directly with the customer.
 
Thank you
Tanya H[redacted]

Dear [redacted],Thank you for this information. I have reveiwed the issue,and a response was sent to the customer in writing on September 28, 2015.Thank you.Rae B[redacted]

We are writing in response to your inquiry dated April 25, 2016, referencing Ms. [redacted]’s claim for Long Term Disability (LTD) benefits. Ms. [redacted] was covered under her employer provided, fully insured Long Term Disability (LTD) policy [redacted]. This policy was underwritten by...

[redacted] ([redacted]) and issued in the state of Tennessee. In Ms. [redacted]’s letter, she indicated that she disagrees with our adverse determination for her ongoing LTD benefits. Due to strict privacy guidelines, we are unable to provide you with detailed information regarding Ms. [redacted]’s claim. However, we would like to clarify the policy terms that impacted her claim and address her concern. Ms. [redacted]’s claim for STD benefits was approved and benefits were paid from June 27, 2014 through December 11, 2014, as she treated for her condition. Because Ms. [redacted] received the maximum STD benefit under this policy, her claim was transitioned to a Long Term Disability Team for consideration of eligibility for benefits under the LTD policy. According to the review of the medical information, Ms. [redacted]’s LTD claim was approved. Based on the policy provision, benefits would be paid through December 11, 2016, providing she remained totally disabled, due to her condition. Our letter dated February 6, 2015, explained that we would continue to monitor her LTD claim, and periodically request updated medical information to confirm her restrictions and limitations. The payments of future benefits would depend on confirmation of her continued disability status and other applicable policy provisions. We requested and received updated medical documentation from Ms. [redacted]’s treating providers, which was reviewed by our medical specialists. Based on the review of this medical information and Ms. [redacted]’s file as a whole, the reviewers concluded that the medical information received to date did not provide measured clinical assessments to support the presence of significant functional impairment related to her condition. Therefore, it was concluded that Ms. [redacted] did not satisfy her policy’s definition of disability beyond December 11, 2015, and her file was closed. On December 17, 2015, we sent a letter to Ms. [redacted], explaining the reason for our decision and outlining information that might be helpful to perfect her claim. On December 30, 2015, we received additional medical information. This newly received information was reviewed by our medical staff, but it did not change our prior decision as no additional clarification of Ms. [redacted]’s condition was provided for review. A letter was sent to Ms. [redacted] to further explain our decision and next steps available to her. On February 16, 2016, we received Ms. [redacted]’s appeal request with additional medical information from her treating provider. As part of the appeal process, we referred her file to the Disability Appeals Team where it was assigned to Appeal Specialist Angela A. for review. The medical documentation within Ms. [redacted]’s LTD claim, along with additional information received during the appeal, was evaluated by an independent medical doctor. After considering all available information, our prior decision was affirmed and Ms. [redacted]’s LTD claim remained closed. A letter was sent to her on March 10, 2016, outlining our decision and next steps available to her. According to our review, Ms. [redacted] still has the opportunity to request a second, voluntary appeal and our decision letter dated March 10, 2016, explains the appeal process. We are fully committed to conducting full and fair reviews of all claims and because a second appeal is considered voluntary for both Ms. [redacted] and [redacted], additional medical documentation not previously reviewed would be required prior to accepting this request. On March 21, 2016 and April 8, 2016, Ms. [redacted] submitted a second, voluntary appeal. We were unable to accept these appeals because the medical documentation received did not provide information to support impairment that would preclude her from working. In the meantime, should Ms. [redacted] have any questions regarding her appeal or the appeal process, she may contact Angela at ###-###-####  for further assistance. We hope the information provided is helpful. Should you have any questions or would like to discuss this matter further, please feel free to contact me directly at ###-###-####. Sincerely, Millie I[redacted] Millie I[redacted] Consumer Advocacy Specialist