CIGNA

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution has been met with customer.
Charlene V[redacted]
Executive Office Advocacy Team

Dear [redacted],Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint regarding [redacted]’s concerns that her Cigna Home Delivery account had been compromised. I can confirm that a resolution letter was mailed to the customer on February 6, 2018.Rae B[redacted] | Operations Specialist | Executive Office Advocacy Team   Phone: ###-###-#### | Fax: [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.]
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.  the payment check was finally written 3 months an 2 days after the service was performed which is late and unsatisfacrory service by cigna and they require reprimanding by the insurance authorities to prevent this kind of performance in the future to me and fellow clients. 
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. 
Regards,
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and a resolution letter was sent to the customer on August 17, 2016.Rae B[redacted]Executive Office Advocacy Team

----- Forwarded message...

----------From: Revdex.com of Metro Washington DC<[email protected]>Date: Wed, Feb 22, 2017 at 9:36 AMSubject: Fwd: Complaint # [redacted]- CIGNATo: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted] <[redacted].net>Date: Tue, Feb 21, 2017 at 7:41 PMSubject: Complaint # [redacted]- CIGNATo: [email protected]: [redacted] <[redacted].net>, "[redacted]" <[redacted].net>To: Revdex.com of Metro Washington DC & Eastern Pennsylvania[redacted], Operations Team[redacted],My wife did not respond to the request for a response because she had not been contacted by Cigna at that time.Shortly thereafter, she was contacted by upper management of the company who profusely apologized for their behavior. He confirmed that his employee did, in fact, run my wife's outdated debit card after she had been provided with the new card information. Furthermore, an erroneous email was sent to my wife stating her monthly payment had been successfully processed followed by another email shortly there after stating that the account was in arrears and a $50 payment would have to be made to reinstate  the policy.The $50 fee request was cancelled and the insurance policy remains in effect.I wish to personally thank everyone at the Revdex.com for their help in resolving this matter.Had the Cigna CSR and her supervisor, taken ownership of their mistake, this complaint would never have been necessary.Thanks again for the outstanding work you do.Sincerely,[redacted] & [redacted]Sent from my [redacted] Air

Thank you for this Inquiry- this was received on 8/29/2014.  Resolution will be sent to the customer directly.
 
Thank you,
Nicole P[redacted]

Dear [redacted], Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint regarding [redacted]’s concerns about the accuracy of the online IFP-Missouri Cigna Connect Network directory. I can confirm that a resolution letter was mailed to the customer on February 20, 2018.  Rae B[redacted] | Operations Specialist | Executive Office Advocacy Team

Thank you for this information. We will contact the customer directly.
 
Thank you,
[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:The specialist who reviewed my complaint did not read it correctly. I was talking about the site being misleading and making me believe I can use my MRA fund for dental reimbursement. She responded about reviewing a phone call; that's not what I asked to be reviewed. I will add attachments of the misleading information on the website to make it clearer.
Regards,
[redacted]

Dear Sir or Madam:We are writing in response to your correspondence dated August 5, 2013, referencing [redacted]'s claim for Short Term Disability (STD) benefits. [redacted] was covered under her employer self-funded STD group benefit policy [redacted]. This plan was administered by [redacted] ([redacted]).
[redacted] raised concerns regarding [redacted]’s decision on her STD claim and her claim experience. 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 her concerns, explain our decision, and provide further administrative options.
With respect to [redacted]'s employer's, [redacted] Retirement Systems, STD plan [redacted], in order for benefits to be payable, her medical records needed to support that her health conditions caused a functional impairment that would continuously prohibit her from performing 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.
While her STD benefits were approved for a time, continued STD benefits were not payable to [redacted] beyond July 20, 2015, because she no longer met the policy’s definition of Disability. This determination was based on our ongoing medical review of the relatively normal findings received from her treating provider. After a complete medical review of the available records on file, it was determined that Ms. De Marco’s condition would not render her Disabled beyond the date referenced above, according to the terms of her STD plan. As a result, no further benefits were payable and her claim was closed. On August 4, 2015, a letter was sent to [redacted], which explained our decision and provided information that may be helpful to perfect her claim.
We understand that [redacted] disagrees with our decision of her STD claim. In conjunction with reviewing her claim, on August 10, 2015, attempted to contact her to offer assistance in filing an appeal. Unfortunately, the attempt was unsuccessful. If there is any additional information that we have not considered, she does have the opportunity to request an administrative appeal review. The August 4, 2013 letter explains how [redacted] can request an appeal. We are fully committed to conducting full and fair reviews of all claims, and will consider any additional information she wishes to provide. Should [redacted] choose to pursue an appeal, she may also contact Senior Claim Manager, Joanna 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 [redacted]. You may also contact CGI's Consumer Advocacy department regarding any group disability, life or accident concerns at:Cigna Consumer AdvocacyAttn: Meredith *. L[redacted]
25600 North Norterra Drive
Phoenix, AZ [redacted]
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 as Answered]
 Complaint: [redacted]
I am rejecting this response because: It is CIGNA is just making an excuse. My complaint is the way CIGNA do business. They lie saying they don't have information from doctors when doctors have proven they have faxed what was requested. We can close this, I just want the public to know how CIGNA does business. I know and have heard I am not alone. I just believe in speaking up.
Regards,
[redacted]

The customer was contacted via phone call on May 1, 2014 and the customer confirmed resolution.

[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 the letter from Cigna stating that my account is now current, but after checking Cigna's online payment portal their correction does not appear - even though the letter states the correction was applied over a month ago. So I am unable to verify that the account has truly been corrected. I have been told numerous times that the correction has been made only to receive another late notice and be forced to start all over again. So this complaint will remain open until I can verify.
Regards,
[redacted]

We are writing in response to your correspondence dated August 30, 2017, regarding [redacted] claim for Short Term Disability (STD) benefits. [redacted] was covered under his employer provided self-funded group STD plan [redacted]. This plan was administered by Life Insurance Company of North...

America (LINA).[redacted] reported concerns regarding LINA’s decision on his STD claim. We appreciate the opportunity to address his concerns, explain our decision, and provide an update on the current status of his claim.Based on our initial review of the information on file, [redacted] was approved for benefits from April 3, 2017 through June 24, 2017, as he sought treatment for his condition. In order to determine if an ongoing functional loss was present, we were required to continue to follow up for updated medical documentation in order to support his ongoing disability.In order to be eligible for and entitled to STD benefits under the State Farm Automobile Insurance Company STD plan, [redacted] was required to continuously meet the plan’s provisions, including its definition of Disability.While [redacted]’s STD benefits were approved for a time, continued STD benefits were not payable to him beyond June 24, 2017, because he no longer met the plan’s definition of Disability. This determination was made based on our ongoing medical review of the available medical findings, and our determination that there were no supported deficits from his providers. After a complete medical review of the available records on file, it was determined that [redacted]’s condition did 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 August 8, 2017, we sent a letter to [redacted] advising of this outcome and his right to appeal.“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include [redacted], Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. © Cigna 2017September 11, 2017 Page 2On August 9, 2017, we received [redacted]’s request for an appeal of our previous determination. His entire claim file, including the additional information submitted in support of his claim, was referred to our appeals team for a separate and thorough review. Based on this review of the available information, the prior determination to deny benefits beyond June 24, 2017 was upheld. This determination was made because the available medical information did not document findings that were determined to support an ongoing functional impairment that would preclude [redacted] from being able to perform the essential functions of his own job. On August 29, 2017, we sent a letter to [redacted] detailing this decision. [redacted] was also notified that under his Employer’s STD plan, he had exhausted all available administrative appeals, and no further appeals would be considered.[redacted] indicated that several pieces of information contained in our letters dated August 8, 2017 and August 29, 2017 were not reflected in his provider’s records. We have reviewed the Behavioral Health Questionnaire and the provider’s records in question, and can confirm that our letter accurately reflects the content of those notes and [redacted]’s functionality.[redacted] also raised concerns regarding the way we interpreted his provider’s records, and our assessment of the frequency of this treatment. While we understand that [redacted] disagrees with this assessment, as outlined in our August 28, 2017 letter at this time he has exhausted his appeals and no further appeal will be considered. Our determination was that an explanation of his functionality and how it continued to prevent him from performing the essential functions of his own job beyond June 24, 2017 was not provided.Thank you for allowing us this opportunity to respond to your inquiry regarding [redacted]’s STD claim. We hope the information provided is helpful. We have confirmed that our appeal specialist, Susan, spoke with [redacted] on August 30, 2017 and September 7, 2017, further discussing our decision. Should [redacted] have any questions or would like to discuss this matter further, he may please feel free to contact his appeal specialist, Susan at ###-###-####. Please also feel free to contact me directly at ###-###-####.

My company--F[redacted]Group- in Greenville,Ohio has Short Term Disability thru Cigna. I am on std leave for a torn rotator cuff, 2 labrum tears and other problems with my right shoulder. I had surgery on October 24 and I will be off 4 months. They make me renew my std every 10-12 days. This company is TERRIBLE to deal with. I have left numerous calls to my case worker and she has NEVER called me back. I would NEVER recommend them to anyone. They are totally RIDICULOUS!!!!!!!! They do nothing to try and resolve my problems.

--------- 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.

Hello-
 
Thank you for your inquiry. This is being reviewed and an outreach will be made to the customer upon completion.
Thank you.

Hello-
This complaint is being addressed.
Thank you.

October 6, 2014
Dear Sir or Madam:
We are responding to a complaint filed by [redacted], which we received on October 3, 2014, regarding her plan benefits and limitations.Our records show that [redacted] had coverage with Cigna/[redacted] plan from September 1,...

2012 through December 31, 2013.The CGUC/[redacted] Sickness and Accident Plan Is a fully insured limited plan with limited benefit structure. The plan has accident benefits which consist of $1,000.00 maximum per occurrence, payable at 80% of eligible charges after a yearly deductible of $50.00 is satisfied. Ths pian allows two occurrences per benefit plan year, injury must occur while covered under the plan and only charges within 90 days of the accident are eligible for benefits.Upon review of [redacted]’s complaint, we found that the claim in question, [redacted], was received for processing on December 14,2013. We were unable to complete the processing of this claim as additional information was needed to rule out work related Injury.The accident detail questionnaire was sent to [redacted] on January 2, 2014. [redacted] returned completed accident detail questionnaire on January 15, 2014 noting that this was not a work related injury. The claims related to this accident were reconsidered on January 22, 2014 allowing plan benefits. [redacted]'s claims were processed to her maximum per occurrence accident benefit for 2013 benefit plan year. No additional benefits are due at this time.Enclosed you will find the Explanation of Benefits for the claims paid in relation to this accident.If you have any questions or concerns regarding this matter feel free to contact me at ###-###-####.Sincerely, 
Millie I 
Regulatory Compliance Analyst