CIGNA

Hello-Thank you for sharing this customer's response. Cigna will contine to review and follow-up directly with the customer with additional information. Tanya H[redacted]Cigna Executive Office of Complaints

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.

October 21, 2015Dear 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] 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

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

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]

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

[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 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

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]

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

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

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

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

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]

[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: It sounds like they did not read the complaint or address their error stating I did not have a biometric screening. I have spent many hours on this issue , hearing many false promises and talking in circles. And now I'm told to jump through another hoop, so I'll fill out the form and send it in.
Regards,
[redacted]

I received your correspondence on April 15, 2016 regarding complaint ID [redacted] from [redacted].
I am a member of the Executive Office Advocacy team, which was established by Cigna to respond to any customer who brings their concerns to the attention of the President and/or the Senior Management Team. I was asked to respond to this matter.
This complaint was closed as unresolved. I would like this to be reconsidered. I responded to the customer's initial request and rejection with written correspondence. I was able to respond directly on the Revdex.com (Revdex.com) website for the initial complaint. The rejected complaint did not have an option to respond on the website. The message that was posted is as follows:
"There is nothing for you to do on this complaint right now."
Under Health Insurance Portability and Accountability Act (HIPAA), Cigna HealthCare may not disclose Protected Health Information (PHI) under these circumstances without an authorization signed by the member. Therefore, if you wish to be advised of the outcome of our investigation, [redacted] must complete the attached written authorizations and return them to me at the address on this letterhead.
Please feel free to contact me at ###-###-#### if you have any questions. We appreciate your assistance in protecting the privacy of our member's Protected Healthcare Information as mandated by law.
Sincerely,
Nicole P[redacted]Executive Office Advocacy Team

[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