CIGNA

February 3, 2014
Dear **. [redacted]:
We are writing in response to your correspondence dated January 30, 2014, regarding **. [redacted]’s claim for Short Term Disability (STD) benefits. She was covered under her employer provided, self - funded STD plan [redacted]...

[redacted], which was administered by [redacted] ([redacted]).
In her letter, **. [redacted] expressed concern regarding [redacted]’s adverse determination for ongoing STD benefits and lack of communication during the handling of her claim. We appreciate the opportunity to explain [redacted]’s decision and address her concerns.
On November 11, 2013, we received **. [redacted]’s claim for STD benefits. Based on our initial review of her medical records, her claim was initially approved for the period of November 11, 2013 through December 4, 2013. For ongoing benefits to continue, we needed to assess how **. [redacted]’s ongoing medical condition impacted her ability to function, and whether it continued to prevent her ability to return to work. For this purpose, we followed up with her treating physician to monitor her progress.
On December 11, 2013, we received **. [redacted]’s medical records. The information received consisted of an office visit note dated December 4, 2013. This information was reviewed by a [redacted] Nurse Case Manager.
The review noted that the medical information did not provide sufficient details to measure the severity of **. [redacted]’s ongoing condition or how it was impacting her ability to function and perform her work duties beyond December 4, 2013. Specifically, there were no clinical or observed findings documented, other than her reports of back and knee pain, demonstrating a severe functional impairment. Based on this information, and the review of her file as whole, we determined that the information provided did not substantiate an ongoing Disability beyond December 4, 2013, and her claim was closed.
Regarding the lack of communication, we would like to clarify our contact timeline. On November 13, 2013, we reached out to **. [redacted] to conduct the initial STD interview. However, we were unable to reach her. According to an automated message, her voice mail was not set up and we were unable to leave a message. On this same date we mailed out a letter acknowledging the receipt of her claim. On November 18, 2013, we reached out to **. [redacted] again. During the conversation she confirmed her treating physicians and we informed her that we would be requesting medical information on her behalf. On December 5, 2013, we received a voicemail from **. [redacted] indicating she would be off work until her next doctor’s appointment.
On this same day we returned **. [redacted]’s phone call and left her a message requesting a call back to discuss her claim. On December 10, 2013, we contacted **. [redacted] and notified her of the claim approval. We also informed her that to be eligible for ongoing benefits additional medical information would be requested on her behalf. On January 03, 2013, we reached out to inform her of our adverse determination for ongoing benefits. However, we were unable to reach her. On January 9, 2013, we successfully contacted **. [redacted] and informed her of our decision. In addition, we offered assistance with the appeal process.
Subsequent to our decision, on January 23, 2014, we received **. [redacted]’s request for an administrative appeal review. As part of the appeal process, we referred her file to the Disability Appeal Team and assigned it to Appeal Specialist (AS), [redacted]., for reconsideration. Upon the completion of the appeal review, and once a decision has been rendered, we will notify **. [redacted] directly of the outcome. We appreciate **. [redacted]’s continued understanding and cooperation as we consider her eligibility for, and entitlement to, ongoing benefits under her STD plan. Should she have any questions or concerns regarding the appeal process, she may contact her AS, [redacted]., at [redacted].
We appreciate the opportunity to be of service and hope that the information provided is helpful to you.
Should you have any further questions or concerns, please do not hesitate to contact our office.
Sincerely,

[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 claim has not been paid for the removal of the tooth and it will be four to six months before the implant can be done and that claim has not been filed or paid yet by cigna. If this complaint is closed then cigna may not pay the claims. I am rqestesting this complaint remain open until All  claims are paid.  The implant has not even been completed yet as the gums have to heal prior to doing the implant.
Regards,
[redacted]

I have catastrophic tinnitus and have been unable to work for the past four years. I have diagnoses from my EMT, Gp, neurologist, audiologist, acupuncturist and others. All are in agreement that I am not fit to work. Cigna has rejected my claim and then ultimately approved it after a nine month battle for my last two appeals. Once an independent medical review team is called in which takes 6 to 9 months my case has been approved. Then Cigna in as little as three months can review the case and again decline coverage. Each time I spend thousands in legal bills to challenge the denial. Given the catastrophic nature of the condition and the exhaustive paperwork filed Cigna ultimately has paid. Their behavior is driven by cost savings and excluding clients such as myself who are disabled. My only advice in dealing with CIGNA is hire yourself a lawyer immediately even before you filing your first claim. Expect that they search for anyway to keep from paying, including perhaps waiting for you to die. This company should be shut down. Its practices are egregious and injurious to those who have paid for disability and receive little but grief in return. If you have any choice in your disability insurance company, do NOT choose Cigna. The mafia probably offers better coverage. My case has just been denied for the third time. If I could sue these b.....s into bankruptcy I would be happy to do so. They deserve no less.

The customer has been contacted via phone call. Cigna will continue to work with the customer until the matter has been resolved.

[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 was contacted by a Supervisor SAM ID Number [redacted] regarding my inquiry I am experiencing with Cigna.She stated that my request was reviewed and it was approved so I need to submit all my receipts of my previous visit  for a reimbursement.
Regards,
[redacted]

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 [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.   Erica M[redacted] Executive Office Advocacy Team

[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. 
Regards,
[redacted]
Cigna did call me today, I was not home.  I returned the call, the extension I was told to call, was for another person.  I did leave a message.  I will attempt to call again tomorrow.Thank you for your prompt responses.[redacted]

August 18, 2014
Dear [redacted],This letter is in response to your inquiries regarding the above captioned matter on behalf of [redacted] Life Insurance Company, a Cigna company (“Cigna”).[redacted], LLC, ([redacted]), is the third party administrator representing,...

[redacted] Life Insurance Company on the group insurance coverage for the above referenced policy.We have reviewed their findings relating to this matter and concur with their explanation related to the issues raised by [redacted]. If you have any questions feel free to contact me directly.Sincerely,Kristen D[redacted]Sr. Compliance Associate

Hello, Cigna has received this letter at the Executive Office of Complaints, and will reach out to the member directly for resolution. Thank You,

----- Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Thu, Oct 27, 2016 at 2:56 PMSubject: Fwd:To: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted]...

[redacted] <[redacted].com>Date: Thu, Oct 27, 2016 at 1:55 PMSubject: To: [email protected] is [redacted] my  Complaint ID:[redacted] Cigna has contacted me and they finally gave me how much my daughters treatment is thank you guys so muchCindy C[redacted],Trade Practices Consultant Revdex.com

Hello-Thank you for forwarding this customers complaint to Cigna. Cigna will review this customer's complaint and follow-up directly with the customer. Thank youTanya H[redacted]CignaExecutive Office of Complaints

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID , and find that this resolution is satisfactory to me. 
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 at this time.  Rae has been in contact with me and has agreed to work with me to clear up all the problems I am having with getting my son's insurance claims repaid. 
Regards,
[redacted]

We do not have enough information to research this complaint.
We need to know the name, date of birth and ID number for the Cigna customer.
We need to know what type of Cigna Plan the inquiry is in regard to. Example: Medical, Dental, Group, Life.
We need to know...

the name of the person who is filing the complaint and their contact information if it is different from what is listed on the Revdex.com complaint.

[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]

[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 have still not been contacted by Cigna.  There has been no resolution.  This nightmare has now been going on for nearly two years.   They need to pay the claim, like they repeatedly told me they would.  Their business practices are atrocious!
Regards,
[redacted]

The customer was contacted today in regard to Revdex.com complaint # [redacted]. We have discussed her concerns and relayed information regarding her next steps.

I file a claim with Cigna for services I did not get: between November 2013-January 2014. A previous dentist kept submitting claims; like they were treating my son, but were not. I called Cigna Customer several times and informed them; we were not there and requested a reimbursement to the account. Someone, in Cigna got tired of hearing my complaint and referred my complaint to Cigna legal department: without my knowledge or consent. About two and half years later, Cigna stated: “…we can’t do nothing…there is a lock on your account…You need to contact our legal department...” So...legal department put a lock on my account. Basically- I cannot get a refund. Now, it been three years I requested this refund nor have the legal team responded to any business why they have my account. My son, needs his account credited back; his case is very hard. We switched dentist due to billing issues. Basically, when I inquired about the bill, they refused to continue with treatment unless I agree with charges. I did not agree with the charges. So, even though they started the ortho. They did not do any maintain them the whole time I was there. Eventually, the wiring and braces started coming off. However, I was still being charged. I figure, Cigna would not credit me for this services because we were still "there"; meaning I came into the office several times to dispute the bill without treatment. But after we left this Dentist; they continue to charge; even though we both understood I was leaving. I continue to contact Cigna, and update them, and file several complaints about the bills from this dentist office. Cigna stated: “…were are looking into it…” But the verdict came back with neutral results and no credit. About a year later, I found a experienced dentist; who could take a class 3 ortho case. Treatment is good. We have one year left. I want the money to complete his ortho because like I stated he was not treated during the months (November-January) at a previous dentist. Basically the other dentist filed false charges. I made Cigna well aware of this. Cigna had three years to credit this but refused; giving me the address only of their legal team. The problem with the legal team; they are allowing another Dentist to file fraud claims; they put a blockage on my account and they don't have my consent. I feel the legal department is wrong. The legal department is letting a business file false claims. I reported a dentist filing unnecessary claims. Its Cigna problem if they have a dishonest provider. Why lock my account? I also feel Cigna customer service should not have referred me to their legal team making without my consent, then make it necessary to contact them. They know I want my money back. So, what I am to do? Being forced to talk to lawyers. It seems Cigna is making it complex for me to get a refund. If Cigna asked if I wanted their legal. The answer would of been: "Why? Its just a refund." According to the consumer protection laws; a customer should not be unable to use service, when their account is in a billing dispute or question. The services were not rendered and an automatic credit should of been applied. The dentist office of whom I filed the claim had three years to prove their case. They did not. The legal department is put a stoppage for the company that owes me the credit. The legal department is also bias because they make me fell that when the company is ready to file any complaints they are going to act like it is ok. It has been three years and no one disputed my complaint, so my account should of been credited. What is hard about giving my son's credit back. Two weeks ago, I sent a certified letter to Cigna's legal department asking why there is a lock on my account. However, I have decided that I am tried of being bullied and am returning any correspondences. I just don’t feel like I should have to talk with a lawyer.

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and I contacted the customer ON 01/06/2016 via telephone. The members concerns were addressed and noted . In addition, I provided a resolution to the member regarding her FSA debit account.  The following...

complaint has been resolved Erica M[redacted] Executive Office Advocacy Team

A response was sent to the customer this morning via email, asking him to submit his documentation directly to me. We have no record of receiving a claim submission from the customer. Once the documentation is received, we can have his concerns reviewed.