CIGNA

--------- Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Mon, Jul 13, 2015 at 9:10 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, 2015 at 10:54 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]" <[email protected]>Cc: [redacted] <[redacted].com>Cigna did correct their error and I did receive a refund. Please update the complaint file. I am satisfied.

Thank you for this information. I have reviewed the issue and a response was sent to the customer in writing on September 22, 2015. Thank you. Rae B[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 her 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.

They approved my short term disability but keep making excuses about paying me. I have been trying for almost a month. I am unable to work because of cancer treatment and my bills are piling up.

Hello,
Thank you for this information.
Written correspondence has been sent to the customer on 3/10/2016.
Thank you,
Nicole P[redacted]

A written response was sent to the customer on 08-01-14 in regard to Revdex.com complaint # [redacted].

We are writing to respond to your correspondence dated April 21, 2016, regarding Joey [redacted]’s claim for Long Term Disability (LTD) benefits. Mr. [redacted] was covered under his employer provided, fully-insured LTD policy [redacted], which was underwritten by [redacted]) and issued in Georgia.Mr. [redacted] raised concerns regarding Cigna holding out doctor’s reports in our reviews. As we have previously explained directly to Mr. [redacted], during an external medical review records were accidentally left out of those submitted to an independent peer reviewer. Once this was brought to our attention, the records were then forwarded and we sought an addendum from this peer reviewer. We are confident that all of the records have now been considered and that a full and fair evaluation has been completed.Mr. [redacted] also indicated that we asked a specialist if we felt he was physically disabled, which is inaccurate. What Mr. [redacted] is referring to is a peer review report in which a peer reviewer indicated that he found evidence to support restrictions supporting his health condition dating forward from June 2015. We followed up with this reviewer and asked that they provide the earliest date these restrictions would have supported, at which point he confirmed only going forward from June 2015. To qualify for benefits, Mr. [redacted] needed to be deemed continuously disabled from October 29, 2014 forward. Since he was not, we upheld our previous decision to deny him further benefits.Should you have any questions or would like to discuss this matter further, please feel free to contact me directly at ###-###-####.Sincerely,Eric F[redacted]

Received:Jun 29, 2015 12:53:08 PMExpires:Aug 28, 2015 12:53:08 PMFrom:CGI Consumer...

AdvocacyTo:[redacted]@myRevdex.com.orgSubject:Response to Revdex.com ID [redacted]Attachments:Revdex.com ID [redacted].pdfGood morning [redacted].  We were unable to upload our response on Friday to the site.  We understand the issue is that the response link was used previously to acknowledge receipt.  I was instructed by your office to send to your attention so that the issue may be closed correctly. Kindly confirm receipt.  If you have any questions, please do not hesitate to contact me. Thank you.Ruth H[redacted]

May 12, 2014
Dear [redacted]:We are writing in response to your correspondence dated May 2, 2014, and in follow up to our e-mail exchanges regarding **. [redacted] and her claim for Short Term Disability (STD) benefits. As we indicated, **. [redacted] was covered under her...

employer provided self-funded group STD plan [redacted]. This plan was administered by [redacted] ([redacted]).**. [redacted] raised some concerns that her STD benefits have been improperly delayed and requested reimbursement. We would like to take this opportunity to address her concerns.With respect to **. [redacted]’s employer’s, [redacted], Inc., STD plan, in order for benefits to be payable, her condition(s), as documented by her medical findings, needed to support why she was unable to perform the material duties of her Regular Occupation. The policy’s “Definition of Disability/Disabled” lays out these requirements and is defined on page 3 of the enclosed plan.We initially received **. [redacted]’s STD claim on March 13, 2014, and after seeking and reviewing updated medical information from her treating provider it was determined the information on file would support her restrictions from work through April 7, 2014, which was the date her provider released her to return to work. As explained to **. [redacted], if she remained out of work beyond this date, updated medical records would need to be reviewed before any other benefits are payable.On April 21, 2014, updated medical records were received that supported **. [redacted] remaining out of work to her new release to return to work date of April 21, 2014. On April 22, 2014 after her medical review was complete, **. [redacted]’s STD claim was closed, and a final check was released for $1,597.94. This check represented benefits from April 7, 2014 through April 20, 2014, the date beforeshe was released to return to work. Our review of this information, also confirmed that on May 6, 2014, **. [redacted] successfully cashed this benefit check.We acknowledge **. [redacted] feels she is entitled to reimbursement for time spent waiting for our decision. However, her employer’s STD plan does not allow such a reimbursement request to be completed. If for some reason, **. [redacted] has accrued any medical expenses due to [redacted]’s request for ongoing supporting documentation, we will gladly submit repayment for these expenses once an invoice is provided confirming the amount. Should **. [redacted] have any specific questions regarding the reimbursement of these invoices, she can always contact her Claim Manager, [redacted], directly at [redacted] x[redacted] for further assistance.Thank you for allowing us this opportunity to respond to **. [redacted]’s concerns and we hope you find this information helpful. Due to the volume of the supporting documentation, it has been mailed to your attention under a separate cover. Should you have any further questions or require additional information, please do not hesitate to contact our office.Sincerely,

Cigna sent me another release of information form last week,...

which I previously completed so I called them and I spoke with Tikia (sp) and she told me she would send me the requested information AGAIN because she said it looked like it hadn't been sent yet.   I then received the requested information about 3 days later so I think this nightmare is over and I appreciate all of your help! Sincerely, [redacted]

Hello-
Thank you for forwarding this complaint to Cigna. We will follow-up directly with the customer regarding this matter.
Thank you.
Tanya H[redacted]

Hello-
Cigna is in the process of reviewing this customer's complaint and will provide an update directly to the customer.
Thank you
Tanya H[redacted]

Hello,
Thank you for this information.
I have been in contact with the customer and am working to research and resolve the issue.
Thank you,
Nicole

Hello,
 
I have outreached to this customer directly to go over this issue in full detail.
 
Thank you,
Kelly M[redacted]

A confidential communication has been sent to the customer
in response to this issue.Thank you

[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 letter from Cigna. This letter fails to address the bills in dispute. Kaiser Permanente have produced detailed itemized bills indicating the services provided, and the amounts unpaid by Cigna (see attached).  I have sent these bills to Cigna multiple times before. The bills are clear. Cigna's letter contains generic explanation of benefits. They do not address the bills. The figures under "amount billed" in Cigna's explanation of benefits do not match the bills in dispute, they correspond to a different claim. Cigna have failed to produce evidence that they have paid the items in the bill in full.  therefore ** legitimately maintain that Cigna have failed to pay.  Furthermore, Cigna claim they simply ignored this case because the agent handling it had "retired".  This is beyond irresponsible. Please see the copy of the email from my employer's HR indicating that Cigna had agreed to a refund. It seems the company cannot maintain consistency within itself.bottom line is that this issue has caused great inconvenience as well as financial loss to me, solely as a result of Cigna;s mishandling of this case and lack of any effort to resolve it thereafter. Prior email from my  employers benefit : ----------------------------------------------------Hello [redacted],
Sorry this one was sitting with
me last week as there was one last item I was waiting for. I followed up with
Cigna today the main issue is that the provider was behind and had not noted
some of the payments already made by Cigna. Cigna has processed and correct the
claims with the provider. You will receive a refund in the amount of $338.81
from Cigna, please allow up to two weeks for the check to arrive to your home
address.
Please let us know if you have
any questions.
Regards,
Benefits Team
[redacted],
Milpitas, CA [redacted]
F: + ###-###-####[redacted].com
 ---------------------------------------------------------

Complaint: [redacted]
I am rejecting this response because:
------ Forwarded message ----------From: Revdex.com of Metro Washington DC<[email protected]>Date: Mon, Aug 3, 2015 at 10:53 AMSubject: Fwd: Complaint #[redacted] - CIGNA CorporationTo: [redacted] <[redacted]@myRevdex.com.org>
---------- Forwarded message ----------From: [redacted] <[redacted]@[redacted].net>Date: Fri, Jul 31, 2015 at 9:27 PMSubject: Re: Complaint #[redacted] - CIGNA CorporationTo: "[email protected]" <[email protected]>
Attn: [redacted] 
I have not contacted you to say whether I am satisfied with the the resolution of this complaint because there has been no resolution.  I have not heard from CIGNA other than a note saying they are investigating.  I would like to believe this is true and not simply a stall tactic.
[redacted] Sent from my [redacted]
Regards,
[redacted]

October 21, 2015
Dear Sir or Madam:
We are writing in response to your correspondence dated October 13, 2015, referencing [redacted]’s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer fully insured STD group benefit policy...

[redacted]. This policy was underwritten by [redacted] ([redacted]).[redacted] raised concerns regarding [redacted]’s overpayment amount related to her STD benefits. Please allow us this opportunity to address her concerns and provide a status update.
With respect to [redacted]’s STD benefit, our records indicate that she was initially paid through September 30, 2015. Upon further review of her benefit calculation it was determined that she had been overpaid in the amount of $1,342.42. In a letter dated September 30, 2015, our Overpayment Recovery Team (ORT) advised [redacted] of this amount.
We understand that [redacted] disagrees with our ORT request to repay this amount in full. In conjunction with reviewing her claim, on October 20, 2015, I attempted to contact [redacted] to address her concerns and provide an updated status of her request. Unfortunately, this attempt was unsuccessful. According to our review, on October 10, 2015, [redacted] and our ORT settled on an agreement, which would allow her to repay the complete overpayment amount in four separate monthly installments. Should [redacted] have any further questions related to her agreement, she may contact her Overpayment Recovery Specialist, Jim S., directly at [redacted] ext. [redacted] for further assistance.
Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted]’s STD claim. We hope the information provided is helpful. 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 Attn: Meredith *. L[redacted]Routing [redacted] P.O. Pittsburgh, Box [redacted]PA [redacted] Telephone: Facsimile: ###-###-#######-###-####[redacted]@cigna.com
[redacted] Phoenix, AZ [redacted] Email: [email protected] Fax: ###-###-####Sincerely,Rick P.
Consumer Advocacy Specialist

Thank you for forwarding this complaint to Cigna. Cigna is currently reviewing the following complaint and when a resolution has been met I will outreach the member. Please see [redacted]achment for the customer. Erica M[redacted]Executive Office Advocacy Team

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