CIGNA

Good Afternoon,Thank you for this 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 your inquiry requires that I look into your information, I need him to give me permission to share my findings with the Revdex.com. Luke  can grant this permission by signing an Authorization for Use and Disclosure form.  Thank you,Rae B[redacted]Executive Office Advocacy Team

Dear [redacted],
Thank you for this information. I have reveiwed the issue,and a response was sent to the customer in writing on September 28, 2015.
Thank you.
Rae B[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint and resolution letter has been sent to the customer on 09/01/2016.Charlene V[redacted]Executive Office Advocacy Team

Outreach via phone has been made to this customer with resolution to the complaint determined to this point.

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 her to give us permission to share our findings with the Revdex.com. Stephanie Vlcek can grant this permission by signing the attached Authorization for Use and Disclosure form. Heidi *. R[redacted]Executive Office Advocacy Team

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

Hello-
Thank you for forwarding this complaint. Cigna previoulsy reviewed and responded directly to the customer on this issue. In order to release any additional information on this issue, Cigna will need the customer to fill out and return the attached Authorization of Protected...

Health Information form. Without this form on file, Cigna is unable to release any specific information on this issue. Thank you
Tanya H[redacted]
Cigna

Hello,
Thank you for notifying Cigna of this complaint. We will be contacting the customer directly.
Thank you,
Nicole P[redacted]

Hello-
A formal response was mailed out on 11/03/2014. Please allow 7-10 days for delivery.
Thank you.

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

Hello,Thank you for this information.I  confirm written correspondence has been sent to the customer on February 8, 2016 and February 12, 2016.Thank you,Rae B[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: [redacted] still has not been able to have the implant done and it will be august before this can be done. Therefore cigna has not yet completed payment for this service. I am requesting once again to keep my complaint open until cigna has paid for the implant. This should be completed by sept 2014.  Thank you
Regards,
[redacted]

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 Mr. Lefavour  to give us permission to share our findings with the Revdex.com. Mr.Lefavour can grant this permission by signing the attached Authorization for Use and Disclosure form.

I have contacted the customer in regard to the rejection of Revdex.com complaint # [redacted]. The customer has been advised of our next steps.

Hello,Thank you for bringing this matter to Cigna's attention. It was received by Cigna's Executive Office of Complaints and will be forwarded to the appropriate team for follow-up and resolution with the customer.Thanks,[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. A response letter was sent to customer on 06/17/2015.Charlene V[redacted]Executive Office Advocacy Team

September 2, 2015Dear [redacted]:We are writing in response to your correspondence dated August 25, 2015, regarding [redacted]’s claim for Long Term Disability (LTD) benefits. [redacted] was covered under his employer provided, fully-insured LTD policy [redacted], which was underwritten by [redacted]...

[redacted] ([redacted]), and issued in Delaware.[redacted] has brought to our attention his concerns regarding our adverse decision for LTD benefits. We appreciate the opportunity to address his concerns, and to provide his available remedy.Our office received [redacted]’s LTD claim on January 16, 2015. Prior to benefits being approved and payable under the terms and provisions of his LTD policy, it was necessary that we determine his eligibility for, and entitlement to benefits. Once [redacted]’s eligibility was cleared, medical information was requested from his treatment providers for the period of August 6, 2014 to the present.To obtain a better understanding of [redacted]’s conditions as a whole and their level of impact on his ability to function and return to work, his file was reviewed by a Nurse Case Manager (NCM) and a Medical Director (MD). Both the NCM and MD agreed that at the time of review, [redacted]’s available medical information did not support his inability to return to work. Specifically, the restrictions and limitations that were provided by his orthopedic surgeon were not supported by his medical findings. After completing our review, including both medical reviews, it was concluded that [redacted] was not considered disabled under the terms and provisions of his LTD policy, and his claim was closed with no benefits considered payable.On March 10, 2015, [redacted]’s administrative appeal was received, and his file was forwarded to the Appeals Unit for further review. On appeal, medical information was requested from his providers for the period of February 1, 2015 to the present. In addition, our MD completed a peer-to-peer outreach call to [redacted]’s orthopedic surgeon to obtain further clarification on his functionality. Based on the review of [redacted]’s medical records and the outcome of the peer-to-peer outreach, it was the recommendation of the MD that [redacted] was not precluded from returning to work on a full-time basis.After completing our review of [redacted]’s claim as a whole, we were unable to amend the previous claim decision, and his claim remained closed. We understand he disagrees with our claim decision; however, because his policy’s definition of Disability is a functional definition, our review focused on his medical records and the opinions of his treatment providers. During the review we looked at the correlating documentation within his medical records and how his conditions impacted his ability to function and perform his work duties.[redacted] has the opportunity to request a second, voluntary appeal. For the specifics on how to appeal and for a detailed outline of information that may be helpful to perfect his claim, he can refer to our April 8, 2015, appeal decision letter.We appreciate the opportunity to be of service and hope that the information provided has been helpful. Should you have any further questions or concerns, please do not hesitate to contact our office.Sincerely,Bianca W[redacted]

We are writing in response to your April 11, 2016 inquiry regarding Mr. [redacted]'s Short Term Disability (STD) claim. Mr. [redacted] is covered under his employer’s STD Policy VDT [redacted], which was underwritten by Life Insurance Company of North America (LINA) and issued in the state of Florida.In our April 6, 2016, response to your previous inquiry, it was noted that we had received a response from Mr. [redacted]'s treatment provider on April 1, 2016. That information was in the process of being reviewed when we sent our previous response. After review, it was determined that further records were necessary and were requested from Mr. [redacted]’s treatment provider.While we understand that Mr. [redacted] feels that all needed records have been obtained, to ensure a fair and accurate review our claim manager felt it necessary to request additional documentation from his treatment provider. Another response from Mr. [redacted]’s treatment provider has been obtained, and as of April 12, 2016, is under review. Mr. [redacted] will be promptly notified of the outcome of our review, once a decision has been reached. If additional medical information is required from his providers, he will also be notified of this fact.Finally, Mr. [redacted] brought up concerns that his claim manager had gone on vacation and his claim was left idle in her absence. While Mr. [redacted]'s claim manager was out of the office, other claim managers from ourclaims team continued the review of his claim. The claim manager's time out of the office has had no impact on the length of the review.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 CGI Consumer Advocacy

[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]