CIGNA

[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: My Dr. did not release me back to work until 3/9/15 and my claim was first submitted in January 2015 and all notes and information was sent to Cigna indicating the reasons why, and again after sending several notes from my Dr. with detail information, my claim was denied and I was advised that I can request an appeal and I request an independent third party in writing to review my claim and after the 2nd appeal was denied, I ask why didnt my appeal go to a independent third party for review, and Ric P[redacted] advised to me that the appeal still has to be approve to even get to a independent third party which makes no sense. By law Cigna has to follow the external review process which they did not due. This is ridiculous for someone to have to go through, this should have been resolved months ago but again it's a scam people work hard everyday and pay ridiculous premiums and when something happens, these companies get over without paying and nothing is being done about it, so I will fight this to then even if it means taking legal action.
Regards,
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna will review this complaint and will follow up with the customer. Charlene V[redacted]Executive Office Advocacy Team

This complaint has been satisfied by Cigna....Again thanks to the Revdex.com for helping me in this manner.

[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]

May 1, 2015Dear [redacted],As third party administrator for [redacted], we are responding to the Revdex.com complaint filed by [redacted].The insured, [redacted], had a Hospital Indemnity (HIP) and Cancer Care policy, underwritten by [redacted]...

[redacted]. Both policies are supplemental in nature to assist with out of pocket expenses and do not pay billed charges in full,We received notification of [redacted]'s passing on December 12, 2013. We received the initial claim on September 26, 2014. We transitioned into a new claims processing system during this period. We experienced an unexpected delay in processing claims during this upgrade. We apologize to all our members on this technical issue.We reviewed the initial file on October 21, 2014. It was determined that some of the dates of service were outside the timely filing requirement. The underwriter allows a period of 15 months from the date of loss for a claim to be filed without an explanation for the timeliness of the filing. In addition, we required additional documentation to process the claims.There were missing documents, which were required to process claims under both polices, Missing documents included the pathology report showing the first diagnosis of cancer, itemized surgical and anesthesia bills, chemotherapy and/or radiation bills, prescription charges, and patient diagnosis for hospital confinement. We notified the claimant of these requirements on December 12, 2014.We received additional documents from the complainant on February 17, 2015. This submission did not include the explanation regarding the timely filing delay deadline. We made this notification on February 27, 2015.On March 9, 2015, we received the explanation for timely filing delay. On April 29, 2015, the analyst was able to make benefit payments on both policies. We ask that [redacted] please allow 7-10 business days for payments to arrive, Payment details are as follows:Claim Number               Policy            Date Paid            Check#               Total[redacted]                  Cancer               4/29                   6953               $45.65                                                                4/28                   6949          $1,291.00                                                                4/28                   6950             $391.00                                                                4/27                   6943           $2,050.00[redacted]                  Hospital                  4/28                   6947           $2,600.00                                 Income                                                                                         TOTAL         $6,377.65We still require an itemized surgical and anesthesia bill for biopsy and surgery that show procedure codes and incurred charges. Dates of service for these procedures are January 28 to January 30,2013 and November 28 to December 3, 2013.I contacted [redacted] on April 29,2015 and offered my services to help acquire the remaining documents. We agreed to work together to obtain the documents, I will have them expedited through the claims department supervisor, once received. I will remain in close contact with [redacted] until all claims are paid.If you have additional questions, please contact us at ###-###-#### or via email at CustomerRelations@[redacted].com. Our fax number is ###-###-####Sincerely,David C. Quality Assurance Specialist

Received:Mar 16, 2017 12:13:43 PMExpires:May 15, 2017 12:13:43 PMFrom:B[redacted], Rae [redacted]To:[redacted]@myRevdex.com.orgSubject:Revdex.com Complaint ID: [redacted]Good Morning [redacted],I can confirm that [redacted]’s Authorization for Disclosure of Protected Health Information form has been approved and processed  by Cigna's Central HIPAA Unit. I have attached the EOC resolution letter in regard to [redacted]’s Better Business Complaint (Revdex.com) complaint for your records, as I am unable to send the letter through the Revdex.com portal. I am sending [redacted] a hard copy of the letter via United States Postal Service (USPS). Can you please confirm that her complaint has been updated  and advise if you require further specifics. Thank you.Rae B[redacted] | Executive Office Advocacy Team   Phone: ###-###-#### | Fax: ###-###-####

This issue jhas been resolved. A message has been left for the customer if there are any other issues.Tanya H[redacted]Executive Office Advocacy Team

[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: There is not enough effort from Cigna to resolve this issue and it has been almost two months without any phone calls to resolve this issue.
Regards,
[redacted]