CIGNA

Complaint: [redacted]
I am rejecting this response because:------- Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Mon, Jul 13, 2015 at 9:10 AMSubject: Fwd: 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].net>Date: Sun, Jul 12, 2015 at 9:15 AMSubject: Re: 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]>The complaint is not resolved.  CIGNA has not responded.Sent from my [redacted]
Regards,
[redacted]

Thank you for forwarding this rejection to Cigna. The Disclosure of Protected Health Information form the customer is...

referring  to is a release to provide the Revdex.com with our findings.Cigna is actively reviewing this complaint that was received on 12/14/2016.Charlene V[redacted]Executive Office Advocacy Team

I have left a message for the customer to contact me in regard to this Revdex.com complaint. The service issue has been addressed.

[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 got the letter todayI will have you know, my Dr ordered a visiting nurse along with a home health aid to help !e with wound care, bathing, dressing and transport
It is not my fault that care Centrix did not process the Dr orders right 
As a result I fell in the shower and the incision reopened
I underwent a bone graft surgery and you are expecting me to hope in a wet slippery shower on my own , in and out?
Our HR quoted that its covered service
As far as the orthotics, we were given conflicting reasons for the denial
And once again , having avascular necrosis and recovery from as fracture of foot
Qualified me for such service under your plan
As far as the MRI,  because of you process the Dr isn't seeing me anymore
Cigna seems to be known for their difficult and annoying process when it comes to MRI
Much like when I had the onset sx of the fracture in left foot on 12.7.12 it took until 1.25.13 to see a specialist because cigna initially denied me the MRI and I am in this situation today with my feet because I did not get treatment on time
I am getting poor accesses to health care because of your reckless screening process
And quick to deny claims. Adding to that the burden of medical expensse.
Regards,
[redacted]

Cigna has completed our review of this Revdex.com request and a final written resolution will be sent to the customer today, April 14, 2014.

Good Evening,Thank you for this information. Cigna has reviewed and acknowledged this complaint. I can confirm a resolution letter was sent to the customer on February 16, 2017, outlining the steps Cigna has taken to resolve her issues. Rae B[redacted]Executive Office Advocacy Team

Cigna is reviewing this matter and will respond with additional information.  We take patient confidentiality seriouslyProtecting 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 him to give us permission to share our findings with the Revdex.com. Todd Nickel can grant this permission by signing the attached Authorization for Use and Disclosure form. Alicia G[redacted]Executive Office Advocacy Team

We are writing in response to your inquiry dated April 25, 2016, referencing Ms. [redacted]’s claim for Long Term Disability (LTD) benefits. Ms. [redacted] was covered under her employer provided, fully insured Long Term Disability (LTD) policy [redacted]. This policy was underwritten by [redacted]...

[redacted] [redacted]) and issued in the state of Tennessee. In Ms. [redacted]’s letter, she indicated that she disagrees with our adverse determination for her ongoing LTD benefits. Due to strict privacy guidelines, we are unable to provide you with detailed information regarding Ms. [redacted]’s claim. However, we would like to clarify the policy terms that impacted her claim and address her concern. Ms. [redacted]’s claim for STD benefits was approved and benefits were paid from June 27, 2014 through December 11, 2014, as she treated for her condition. Because 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 policy. According to the review of the medical information, Ms. [redacted]’s LTD claim was approved. Based on the policy provision, benefits would be paid through December 11, 2016, providing she remained totally disabled, due to her condition. Our 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 limitations. The payments of future benefits would depend on confirmation of her continued disability status and other applicable policy provisions. We requested and received updated medical documentation from Ms. [redacted]’s treating providers, which was reviewed by our medical specialists. Based on the review of this medical information and Ms. [redacted]’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 condition. Therefore, it was concluded that Ms. [redacted] did not satisfy her policy’s definition of disability beyond December 11, 2015, and her file was closed. On December 17, 2015, we sent a letter to Ms. [redacted], explaining the reason for our decision and outlining information that might be helpful to perfect her claim. On December 30, 2015, we received additional medical information. This newly received information was reviewed by our medical staff, but it did not change our prior decision as no additional clarification of Ms. [redacted]’s condition was provided for review. A letter was sent to Ms. [redacted] to further explain our decision and next steps available to her. On February 16, 2016, we received Ms. [redacted]’s appeal request with additional medical information from her treating provider. As part of the appeal process, we referred her file to the Disability Appeals Team where it was assigned to Appeal Specialist Angela A. for review. The medical documentation within Ms. [redacted]’s LTD claim, along with additional information received during the appeal, was evaluated by an independent medical doctor. After considering all available information, our prior decision was affirmed and Ms. [redacted]’s LTD claim remained closed. A letter was sent to her on March 10, 2016, outlining our decision and next steps available to her. According 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 process. We 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 [redacted], additional medical documentation not previously reviewed would be required prior to accepting this request. On March 21, 2016 and April 8, 2016, Ms. [redacted] submitted a second, voluntary appeal. We were unable to accept these appeals because the medical documentation received did not provide information to support impairment that would preclude her from working. In the meantime, should Ms. [redacted] have any questions regarding her appeal or the appeal process, she may contact Angela at ###-###-####  for further assistance. We hope the information provided is helpful. Should 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

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution letter has been mailed to the customer on 11/22/2016.Charlene V[redacted]Executive Office Advocacy Team

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

The complaint is essentially against the company, process, doctor, and bad service received starting from the receptionist all the way down to the doctor visit and billing procedure.Cigna refused to let me schedule a physical, and forced me to first schedule for my wrist pain. So I made the...

appointment for my wrist but the treatment received was inconsistent with the symptoms expressed. Never did I get any resolution on my wrist. I was just charged over $200 for what would have been covered by insurance during a physical, and nothing was ever done about my wrist which is what my concern was and what I thought I was paying for.It seems Cigna just wanted to get an extra appointment out of me that would not be covered by insurance.

We have been in contact with the customer regarding Revdex.com [redacted]. We will continue to monitor the account.

Thank you for the additional information.I have reached out directly to the customer to address the issue.Thank you,Nicole P[redacted]

Hello-Cigna has completed the requested account audit and has mailed a copy directly to the customer. Thank youTanya H[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]

Hello-A resolution letter was mailed to the custoner on July 30, 2015. If the customer wishes for the results of the review to be shared with the Revdex.com, the [redacted]ached Authorization form will need to be completed and returned to Cigna. Thank youTanya H[redacted]Executive Office Advocacy Team

Hello-
Thank you for forwarding this. Cigna with reach out to the customer to discuss.
Thank you
Tanya H[redacted]

Hello [redacted], please note that this request is still in review. Upon completion a request will be sent to the customer.
Thank you.

Cigna reached out to the customer, [redacted].  Customer's dental predetermination was showing on her member portal as pending, then wasn't there while it was processing.  Customer called to Cigna customer service a few days later and then the claim was there again.  CSA explained...

to the customer about the claim at that point. [redacted] indicated that she has now gotten what she needed from Cigna and that this case can be closed.

A private written response was sent to the
customer as of January 29th, 2016.