CIGNA

From: 
#ffffff; font-variant: normal; font-style: normal; font-family: arial; letter-spacing: normal; color: #222222; font-size: small;">Revdex.com of Metro Washington DC <[email protected]>Date: Mon, Feb 10, 2014 at 11:57 AMSubject: Fwd: Checking on complaint [redacted]To: [redacted] <[redacted]>
---------- Forwarded message ----------
From: [redacted] <[redacted]>
Date: Sat, Feb 8, 2014 at 6:42 PM
Subject: Checking on complaint [redacted]
To: [email protected]
Hi there,
 
I was told my complaint was transferred to your office.  I have new information on my complaint that I wanted to pass along.
 
I have spoken with Cigna twice since I reported my complaint to you.  Both times they have failed to be helpful.  On Thursday they called and left me a message telling me to call them back - I called the exact number they told me to call at 12:35pm Pacific time.  The woman I got on the phone knew NOTHING of my issues with the ID card and raised premium complaints.  She said there was no record, she claimed there wasn't even any record of the call made to me a few minutes before.  She said she didn't know why Cigna even called me.  ??????
 
I of course explained the situation, her response was that it was the post office's fault that I had not received ID cards or notices and explanations of why my premiums have been raised without explanation for over two years. That Cigna had done everything in their power over these last few years and that the post office was to blame.  This is a complete lie.  I received an email from Cigna where an agent told me that they had failed to enter my apartment number for the past two years.  I have attached it.  I cannot express to you how many times I have called Cigna and emailed with requests for them to make sure my address was correct.  Every time they say they will fix the problem.  They did not.
 
The woman would not discuss a refund for my raised premiums, repeating only that it was the post office's fault I was not informed.  Again, I have proof it is Cigna's fault.  
 
When will there be a response from Cigna about my complaints? Do you recommend I report Cigna to another agency as well?  
 
Thanks so much.
 
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution letter has been mailed to the customer on 03/10/2017.Charlene V[redacted]Executive Office Advocacy Team

Thank you for this information.  I will be reaching out to the customer directly to have this issue addressed.
 
Thank you,
Kelly

June
2, 2016Dear
[redacted],We are writing to respond to your
correspondence dated May 25, 2016, regarding [redacted]’s claim for Short Term
Disability (STD) benefits. As you’re aware, [redacted] was covered under her employer’s
self-funded STD plan [redacted], which was administered by [redacted] ([redacted]). Under [redacted]’s STD Plan, all requests for
an administrative appeal are handled by the [redacted]. ([redacted]). [redacted] is a privately owned peer review organization that
independently reviews appeals on behalf of [redacted]. Upon receipt of [redacted]’s
request for an appeal a referral was made to [redacted]. [redacted] does not know the
specific details of how [redacted] conducts their appeal reviews, but we are consulted
about their review. In response to your May 25, 2016
correspondence, we requested an update from [redacted] on the status of [redacted]’s
appeal. As of May 25, 2016, [redacted] has made the determination that the original
denial of STD benefits made by [redacted] should not be overturned. [redacted] is
responsible for sending out all communication regarding this decision, and if
[redacted] has not received a letter regarding their decision she should receive
one shortly. [redacted] should refer to this letter for any remaining appeal
rights she may have under her Employer’s Plan.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]Compliance
Specialist

Good morning,I sent a written response to the customer in regard to his concerns earlier today. The response was sent out via email and regular mail. The claim for the customer was processed on 11-29-16 per the instructions on the electronic claim. This issue has been resolved.

Thank you for forwarding this complaint to Cigna. Cigna is reviewing the complaint, and an acknowledgement letter was sent to the customer on February 6, 2017.

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and several calls have been placed to the member for a call back to specify the complaint . No response. Still working on customers concerns.Erica M[redacted]Executive Office Advocacy Team

Cigna has been in contact with the customer and a resolution has been reached for Revdex.com complaint # [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 do not need to sign a medical release for you to take responsibility and fix the collection incorrect billing problem. That's literally the only thing that needs to be done. You've sent multiple people to call me who don't have the authority to reverse the billing issue. Fix it. And tell me it's fixed. 
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: because they will not even talk to me I want to be compensated for which they will not provide me
Regards,
[redacted]

February 2, 2016
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 decision. Please allow us this opportunity to address his concerns, explain our decision, and provide an updated status.
With 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 occupation. The policy's "Definition of Disability/Disabled” lays out these requirements and is defined on page 2 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 Disability. This determination was based on our ongoing medical review of the relatively stable findings received from his providers. After 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 policy. As a result, no further benefits were payable and his claim was closed. On 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 claim. As 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 LINA's recent correspondence to [redacted], explaining that our prior decision on his claim was overturned on appeal. After reviewing updated medical

Cigna is
actively working with the customer toward resolution of this issue by phone and
correspondence. Details will be given directly to the customer.
Thank you
for bringing this to our attention.

Hello-Thank you for forwarding this customers complaint to Cigna. We will be reviewing this and will follow-up directly with the customer. Thank YouTanya H[redacted]Cigna's Exeuctive Office of Complaints

January 6, 2016
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]).[redacted] raised concerns regarding his most recent STD claim experience and customer service issues. Customer service is extremely important to us and we have communicated this information to the appropriate management to be addressed. Please 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 occupation. The policy's “Definition of Disability/Disabled” as:
The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:
1. unable to perform the material duties of his or her Regular Occupation, and
2. unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular Occupation.
While 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 Disability. This determination was based on our ongoing medical review of the relatively stable findings and imaging reports received from his providers. After 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 plan. As a result, no further benefits were payable and his claim was closed. On December 11, 2015, a letter was sent to [redacted], which explained our decision and further explained the appeal process.
Subsequent to our decision, [redacted] requested that his Claim Manager request further medical documentation from his treating providers to be considered. Although this is not our standard process, on December 12 and December 15,2015, our claims department sent requests for updated information to [redacted]’ treating providers. Upon 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 benefits. Should 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 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 AdvocacyAttn: Meredith *. L[redacted]Phoenix, AZ [redacted]Email: [email protected]: ###-###-####Sincerely,Rick P.
Consumer Advocacy Specialist

[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:
This is not adequate.  When I use the system to get a quote and it shows a $40, I assume it would be $40.  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 $40 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 $210 is outrageous and should not be allowed especially since the $40 was in agreed in principal by marking down on the sheet and taking us back for the exam.  If we were quoted at $210 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 $40 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]

Hello,
 
THank you for this information. I have reached out to the customer to go over the options in regards to any premium reimbursement.  The customer has my direct phone number for any questions.
 
Thanks,
[redacted]

Good afternoon, Cigna's Executive Office of Complaints has received the complaint and will be following up with the customer directly for resolution. Thank You

Hello,
Thank you for this information.
I have called the customer to verify he has received the documentation that was sent. I also have called the facility, as well, to verify the same information. Both have confirmed receipt. I have assured the customer this is the final review of the claim and will not reprocess.
 
Thank you,
Nicole P[redacted]

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

FIRST THEY STOPPED THE CHECKS AT 21 1/2 MONTHS WHEN THE POLICY CLEARLY STATES THAT THE POLICY DEFINATION CHANGES FROM "OWN TO any after 24 months. ON AUG 18TH 2014 THEY DECIDED TO DO THAT AND ON 9/7/14 I FILED AN APPEAL. I GOT ONE EXCUSE AFTER ANOTHER UNTIL ON DEC 19TH 2014 I FOUND OUT THAT AN EMPLOYEE HAD TAKEN A LEAVE AND FOR 122 DAYS THE CLAIM HAD SET ON HER DESK. I BELIEVE THE LAWS AND REGULATIONS STATE THAT THEY HAVE 45 DAYS AND IN AN EMERGENCY SITUATION EVEN LESS.
DURING THIS TIME JOEY HAD NO INSURANCE OR CASH TO SEE ONE. WHEN THE PEER REVIEW WAS DONE (SEE ATTACHED) THEY FOUND HIM DISABLED AND PAID THE 2 1/2 OTHER MONTHS. SO THEY SENT A CHECK 12/28/14 AND ON JAN 6TH 2015 THEY SHUT IT BACK OFF. SO I FILED ANOTHER APPEAL. EVERY 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 OUT. WE HAVE NOT ONCE SAID THAT HE IS MENTALLY INCAPIBLE UNTIL THIS LAST REPORT. BUT 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-WORKERS. AND HE CANT TAKE THE MEDS AND EVEN DRIVE TO WORK. BUT THE PSY DOCTOR ALSO FOUND HIM DISABLED. AND WHEN HE DID THEY ASK HIM TYO JUDGE AS TO WEATHER HE WAS IN OCT 2014. NO HE WASNT THEN. AND I DIDNT STATE THAT IN THE LETTER. I STATED THAT HE HAD NO RIGHT TO DO THAT FROM A TIME PERIOD WHEN THE CLAIM SET ON A DESK GETTING NOTHING DONE. AND IN THAT PEER REVIEW IN WHICH THE TIME FRAME DID COVER FURTHER PAYMENTS THERE WAS ALSO SOME REPORTS MISSING. IF THEY HAD ACTUALLY WORKED ON THIS AND SENT OUT REQUEST OR CALLED A DOCTOR OR TWO THEY COULD HAVE FOUND OUT. THIS WAS HANDLED IMPROPER FROM THE BEGINNING BECAUSE THEN THERE WERE 21 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 65 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 PEOPLE. THEY LEFT THAT PART OUT. AND THEY NEVER SAID HEY WE CAN'T TAKE YOUR MONEY BECAUSE.... ALL PAYMENTS WERE ACCEPTED AND NEVER LATE.
SO THIS IS WHY I AM REFUSING THEIR OFFER. FOR 4 YEARS WE HAVE ARGUED AND FOR 4 YEARS EVERY DOCTOR STATES THAT HE CAN NOT PHYSICALLY WORK. AT ANY JOB REGARDLESS. HE 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.