CIGNA

February 2, 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 decisionPlease allow us this opportunity to address his concerns, explain our decision, and provide an updated statusWith 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 occupationThe policy's "Definition of Disability/Disabled” lays out these requirements and is defined on page of the enclosed policyWhile 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 DisabilityThis determination was based on our ongoing medical review of the relatively stable findings received from his providersAfter 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 policyAs a result, no further benefits were payable and his claim was closedOn 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 processSubsequent to our decision, [redacted] requested an administrative appeal review of his LTD claimAs part of our process, his entire file was referred to an independent peer reviewer for evaluationFor 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 appealAfter reviewing updated medical

[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: [redacted] I am rejecting this response because:Cigna has made no effort to address or remedy the issues they have caused directly and by their own admission They sent me a check only for the amount they stole but did nothing to address the hundreds of dollars in overdraft fees or lost hours I am out over $because of a mistake they admit making and that they did nothing to prevent Regards, [redacted] ***

Hello, Thank you for this informationI have been in contact with the customer and am working to research and resolve the issueThank you, Nicole

Thank you for the informationCigna has resolved this issue and will be contacting the customer directlyIn order to provide specific policy information, the customer will need to complete the attached Authorization of Disclosure of Protected Health Information

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

I finally received the second check from Cigna so this matter is resolved Regards, [redacted]

[A 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 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, [redacted] ***

[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 this information I will have an audit completed on this account and upon completion reach out to the customer to go over information Thank you, [redacted] ***

Hello, I have outreached to this customer directly to go over this issue in full detail Thank you, Kelly M***

Thank you for this request, a letter was sent to customer directly Thank you, Kelly M***

[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: [redacted] I am rejecting this response because: the response that was given has nothing to do with the initial reasonI have been through the ringer with this company and its lack to provide a with and accurate informationI am aware that this is the last step to were you can help and that's fine but I know my claim is valid and I will not sit by any longer run around town getting documents they should get to expedite the process with no apology for there lack of following there own mission statement or mottoI will reach out to my job and I have contacted a lawyer today to represent meSince they are stating they are in the right and it is all on me fineSee you in courtIt's sad when you complain and all the way to corporate and nothing is done or some type of resolution for both partiesI will never never use this company again I rather decline a job that deals with them because they do not help Regards, [redacted]

[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 months an 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]

Hello- Thank you for forwarding this customers complaint to CignaCigna will review this customer's complaint and folldirectly with the customer Thank you Tanya H [redacted] Cigna Executive Office of Complaints

[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: [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]

I spoke with [redacted] this morning to advise her that her concerns have been resolved

FIRST THEY STOPPED THE CHECKS AT 1/MONTHS WHEN THE POLICY CLEARLY STATES THAT THE POLICY DEFINATION CHANGES FROM "OWN TO any after monthsON AUG 18TH THEY DECIDED TO DO THAT AND ON 9/7/I FILED AN APPEALI GOT ONE EXCUSE AFTER ANOTHER UNTIL ON DEC 19TH I FOUND OUT THAT AN EMPLOYEE HAD TAKEN A LEAVE AND FOR DAYS THE CLAIM HAD SET ON HER DESKI BELIEVE THE LAWS AND REGULATIONS STATE THAT THEY HAVE DAYS AND IN AN EMERGENCY SITUATION EVEN LESS DURING THIS TIME JOEY HAD NO INSURANCE OR CASH TO SEE ONEWHEN THE PEER REVIEW WAS DONE (SEE ATTACHED) THEY FOUND HIM DISABLED AND PAID THE 1/OTHER MONTHSSO THEY SENT A CHECK 12/28/AND ON JAN 6TH THEY SHUT IT BACK OFFSO I FILED ANOTHER APPEALEVERY 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 OUTWE HAVE NOT ONCE SAID THAT HE IS MENTALLY INCAPIBLE UNTIL THIS LAST REPORTBUT 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-WORKERSAND HE CANT TAKE THE MEDS AND EVEN DRIVE TO WORKBUT THE PSY DOCTOR ALSO FOUND HIM DISABLEDAND WHEN HE DID THEY ASK HIM TYO JUDGE AS TO WEATHER HE WAS IN OCT NO HE WASNT THENAND I DIDNT STATE THAT IN THE LETTERI STATED THAT HE HAD NO RIGHT TO DO THAT FROM A TIME PERIOD WHEN THE CLAIM SET ON A DESK GETTING NOTHING DONEAND IN THAT PEER REVIEW IN WHICH THE TIME FRAME DID COVER FURTHER PAYMENTS THERE WAS ALSO SOME REPORTS MISSINGIF THEY HAD ACTUALLY WORKED ON THIS AND SENT OUT REQUEST OR CALLED A DOCTOR OR TWO THEY COULD HAVE FOUND OUTTHIS WAS HANDLED IMPROPER FROM THE BEGINNING BECAUSE THEN THERE WERE 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 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 PEOPLETHEY LEFT THAT PART OUTAND THEY NEVER SAID HEY WE CAN'T TAKE YOUR MONEY BECAUSEALL PAYMENTS WERE ACCEPTED AND NEVER LATE SO THIS IS WHY I AM REFUSING THEIR OFFERFOR YEARS WE HAVE ARGUED AND FOR YEARS EVERY DOCTOR STATES THAT HE CAN NOT PHYSICALLY WORKAT ANY JOB REGARDLESSHE 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

[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: [redacted] I am rejecting this response because: When was the issue of money being taken from my account without my authorization ever resolved? My account was in the negative because that mistake and I was never returned what I am owedIf the rolls were reversed and I owed your company money, you people would've sent my account to a collection agency by nowAn incompetent firm with apathetic, insincere employees screws me over, and all I'm offered is a mediocre apology with no assurance of repaymentThe issue was "addressed," but not RESOLVED Regards, [redacted]

Two outreach attempts made to the customer to obtain additional information in order to review customers concerns To date, customer has not returned any callsLetter has been sent to the customer requesting additional information Heather B [redacted] ***

[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: [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 insuranceCigna accepted five payments and rejected all of my claimsThis is utterly ridiculousI would not have went to the dentist if cigna would not have enrolled me in an individual planI had to pay a lump sum to my dentistCigna is a very unprofessional company that does not pay attention to detailThis is the most horrible customer service, to make a customer pay for a business's mistake Regards, [redacted]