CIGNA

Hello-Thank you for forwarding this customer's complaintCigna has begun reviewing the complaint and will provide folldirectly with the customer.Tanya H***

[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:The recent message from the company states, "An electronic response was sent to the Revdex.com in regard to complaint # [redacted] for [redacted] [sic] [redacted] on 06-27-14."This information is not showing Regards, [redacted]

Hello-Thank you for forwarding this customers complaint to CignaWe will be reviewing this and will folldirectly with the customerThank YouTanya H***Cigna's Exeuctive Office of Complaints

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] (***) 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 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 occupationThe policy’s “Definition of Disability/Disabled" lays out these requirements and is defined on page 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 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 process.Subsequent 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 evaluation.For your reference, we have enclosed a copy of ***'s recent correspondence to [redacted] ***, explaining that our prior decision on his claim was overturned on appealAfter reviewing updated medical information with an independent peer reviewer, it was agreed the information on file would support [redacted] ***'s inability to perform any occupationAt this time, his claim has been forwarded to the Director of the Claims Department for reinstatementOn January 28, [redacted] was advised of this outcome and processOnce this process is complete [redacted] ***'s Claim Manager, Mark Wwill contact him and advise of the retroactive benefit amount that is being released to himIn 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 claimWe hope the information provided is helpfulDue to the volume, the Supporting documentation has been mailed to your attention under a separate coverShould 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 PConsumer Advocacy Specialist

Greetings,Thank you for forwarding this complaint to CignaCigna has reviewed this complaint and a resolution letter has been sent to the customer on July 11, Rae B [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 responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: This is not adequate When I use the system to get a quote and it shows a $40, I assume it would be $ Another doctor referred me to this doctor because they felt there was a valid reason for concern The paper I attached to the complaint show they filled out $and then crossed it off after the exam It is absolutely not right to be under the assumption that I will be paying $40, then at the end when there was no problem indicated saying it will be $is outrageous and should not be allowed especially since the $was in agreed in principal by marking down on the sheet and taking us back for the exam If we were quoted at $we would have considered other methods Furthermore this plan has [redacted] vision and when using the Estimate your cost tool for an Optometrist it shows the $copay as being valid for In Network doctors This resembles a bait and switch tactic, except we had no out since we did not know about the inflated cost until after the exam was complete and went to pay Regards, [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: There is still no clear reason why it took almost a month to even get my claim startedCigna received several messages from me and I even had my human resources manager e-mail them to find out why it was taking so long for any paperwork to be sent to meClearly this companies customer service failed me on more than one occasionAnd the only time I got a quick response is when I filed this complaint with the Revdex.comMy disability plan may not cover any additional payments to cover late fees...past due rent...and the stress that Cigna caused me but as a company they should have some type of funds available when they have failed as a company to provide the services they are there forThis company took no responsibility for the way they have handled my case except to say they understand the stress it has caused...but what are they going to do to make sure this doesn't happen to someone else? Or to compensate me for the errors and lack of communication they showed me?? Regards, [redacted]

If you have a health care provider choice through your place of employment do not choose Cigna I applied for short term disability due to a spinal cord injury and applied for STD on my doctors recommendation and was refused the claim by some incompetent doctor that probably can't maintain his own practice I had seen neurosurgeons and several orthopedic doctors who said my injury is permanent This was the first time I ever applied for any type of disabilityJust read the reviews on line from numerous people who either had their STD or LTD pulled or denied by Cigna They were even sued several years ago in a class action suite by states.for these practicesif there was a regulating agency out there cigna would not be in businessBe warned, Cigna loves to take your money but will avoid payouts at any cost to its participants Drop Cigna if you think you may need disability gave them a star because there is nothing lower

--------- Forwarded message ----------From: Revdex.com of Metro Washington DC Date: Mon, Jul 13, at 9:AMSubject: Fwd: FW: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint # [redacted] .To: [redacted] < [redacted] @myRevdex.com.org>---------- Forwarded message ----------From: [redacted] < [redacted] @***.com>Date: Sun, Jul 12, at 10:AMSubject: FW: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint # [redacted] .To: "[email protected]" Cc: [redacted] < [redacted] @***.com>Cigna did correct their error and I did receive a refundPlease update the complaint fileI am satisfied

We are writing in response to your inquiry dated April 25, 2016, referencing Ms [redacted] ***’s claim for Long Term Disability (LTD) benefitsMs [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 TennesseeIn Ms***’s letter, she indicated that she disagrees with our adverse determination for her ongoing LTD benefitsDue to strict privacy guidelines, we are unable to provide you with detailed information regarding Ms***’s claimHowever, we would like to clarify the policy terms that impacted her claim and address her concernMs***’s claim for STD benefits was approved and benefits were paid from June 27, through December 11, 2014, as she treated for her conditionBecause 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 policyAccording to the review of the medical information, Ms***’s LTD claim was approvedBased on the policy provision, benefits would be paid through December 11, 2016, providing she remained totally disabled, due to her conditionOur 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 limitationsThe payments of future benefits would depend on confirmation of her continued disability status and other applicable policy provisionsWe requested and received updated medical documentation from Ms***’s treating providers, which was reviewed by our medical specialistsBased on the review of this medical information and Ms***’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 conditionTherefore, it was concluded that Ms [redacted] did not satisfy her policy’s definition of disability beyond December 11, 2015, and her file was closedOn December 17, 2015, we sent a letter to Ms***, explaining the reason for our decision and outlining information that might be helpful to perfect her claimOn December 30, 2015, we received additional medical informationThis newly received information was reviewed by our medical staff, but it did not change our prior decision as no additional clarification of Ms***’s condition was provided for reviewA letter was sent to Ms [redacted] to further explain our decision and next steps available to herOn February 16, 2016, we received Ms***’s appeal request with additional medical information from her treating providerAs part of the appeal process, we referred her file to the Disability Appeals Team where it was assigned to Appeal Specialist Angela Afor reviewThe medical documentation within Ms***’s LTD claim, along with additional information received during the appeal, was evaluated by an independent medical doctorAfter considering all available information, our prior decision was affirmed and Ms***’s LTD claim remained closedA letter was sent to her on March 10, 2016, outlining our decision and next steps available to herAccording 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 processWe 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 ***, additional medical documentation not previously reviewed would be required prior to accepting this requestOn March 21, and April 8, 2016, Ms [redacted] submitted a second, voluntary appealWe were unable to accept these appeals because the medical documentation received did not provide information to support impairment that would preclude her from workingIn the meantime, should Ms [redacted] have any questions regarding her appeal or the appeal process, she may contact Angela at ###-###-#### for further assistanceWe hope the information provided is helpfulShould 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

[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 the additional information.I have reached out directly to the customer to address the issue.Thank you,Nicole P [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 as Answered] Complaint: [redacted] I am rejecting this response because: Erica called me on 12/to say records have arrived and she would call me with results by 12/This is 12/and she still has not called meIt has been over months and still no resolution Regards, [redacted]

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

I have had several different medical and dental insurance companies over the yearsMy experiences with Cigna have by far been the worstActually, I don't recall having a negative experience with other insurance organizationsMy experience with Cigna has been so bad that I think I would be better off without insuranceEach time a person in my family visits a doctor or medical professional of any kind I receive multiple correspondences from CignaI am told that they have evidence that my family is covered by another health insurance policy - which is not the caseNevertheless, I have to complete the form EVERY TIMEI also get a form that I have to complete which inquires about where the injury occurredIf it occurred on a commercial property then I have to provide that organization's insurance information to themIf these correspondences occurred on occasion I wouldn't be as annoyed, but they occur every time we use our insurance - even for routine check upsFor a family of five that has both medical and dental, this paperwork adds upThe worst thing about Cigna though is their FSA systemThey 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 systemCigna 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 EOBsIn essence I have to print the EOBs from the Cigna website then fax them back to CignaMore recently, they are saying that because my specific dentist's name is not on the itemized bill that they cannot unfreeze my accountThe 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 moneyThe FSA transactions do not list the dentist's name -only the dental officeYet, they say that the information on both much matchThey do match - the itemized bill and the transactions in FSA both contain the same dental office information

A written response has been sent to the customer today in regard to Revdex.com complaint # [redacted]

Hello- A formal response was mailed out on 11/03/Please allow 7-days for deliveryThank you

January 6, Dear Sir or Madam: We are writing in response to your correspondence received on December 29, 2015, referencing [redacted] ' claim for Short Term Disability (STD) benefits [redacted] was covered under his employer self-funded STD group benefit plan [redacted] This plan was administered by [redacted] (***)[redacted] raised concerns regarding his most recent STD claim experience and customer service issuesCustomer service is extremely important to us and we have communicated this information to the appropriate management to be addressedPlease allow us this opportunity to address his concerns, explain our decision, and provide an updated status of his claim.With respect to [redacted] employer's STD plan [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 occupationThe policy's “Definition of Disability/Disabled” as: The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is: unable to perform the material duties of his or her Regular Occupation, and unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular OccupationWhile his STD benefits were approved for a time, continued STD benefits were not payable to [redacted] beyond November 30, 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 and imaging reports received from his providersAfter a complete medical review of the available records on file, it was determined that [redacted] ' condition would not render him Disabled beyond the date referenced above, according to the terms of his STD planAs a result, no further benefits were payable and his claim was closedOn December 11, 2015, a letter was sent to [redacted] , which explained our decision and further explained the appeal processSubsequent to our decision, [redacted] requested that his Claim Manager request further medical documentation from his treating providers to be consideredAlthough this is not our standard process, on December and December 15,2015, our claims department sent requests for updated information to [redacted] ’ treating providersUpon receiving this updated documentation and reviewing it with our medical experts, it was determined that [redacted] would be unable to perform the duties of his Regular Occupation and on January 5,2016, his STD benefits were reinstated,At this time, [redacted] ’ STD claim remains active as he continues to be eligible for STD benefitsShould he have any questions regarding his STD claim status or payment he can contact his new Claim Manager, Andrew W., directly at ###-###-#### for further assistance.Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted] ’ STD claimWe hope the information provided is helpfulShould 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 AdvocacyAttn: Meredith *L [redacted] ***Phoenix, AZ [redacted] Email: [email protected]: ###-###-####Sincerely,Rick PConsumer Advocacy Specialist

Hello-Cigna has completed the requested account audit and has mailed a copy directly to the customerThank youTanya H***

Please be advised that a final response was sent to the customer today (2/28) advising that his plan does require a deductible for medications before the plan will pay at 100%Any questions customer may contact Cigna Customer Service Thank you