CIGNA

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

[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]

If you have a health care provider choice through your place of employment do not choose Cigna. I applied for short term disability due to a spinal cord injury and applied for STD on my doctors recommendation and was refused the claim by some incompetent doctor that probably can't maintain his own practice. I had seen 3 neurosurgeons and several orthopedic doctors who said my injury is permanent. This was the first time I ever applied for any type of disability. Just read the reviews on line from numerous people who either had their STD or LTD pulled or denied by Cigna. They were even sued several years ago in a class action suite by 5 states.for these practices. if there was a regulating agency out there cigna would not be in business. Be warned, Cigna loves to take your money but will avoid payouts at any cost to its participants. Drop Cigna if you think you may need disability. gave them a 1 star because there is nothing lower.

Hello
Thank you for forwarding this complaint. Cigna will review the customers account and follow-up directly with the customer.

Customer's complaint has been resolved and a letter sent to him today (January 30th).
Thank you.

Customer's request was completed and a response sent on 5/6/2014. Please expect to receive our response in 5-7 days.
Thank you.

Please be advised that a final response was sent to the customer today (2/28) advising that his plan does require a deductible for medications before the plan will pay at 100%. Any questions customer may contact Cigna Customer Service.
 
Thank you.

Our office has sent [redacted] a letter and confirmed with Cigna Individual Family Plans that her account is current and that all payments have been posted. No further notices will be sent. 
Thank you.

Thank you for this information, It will be reviewed and outreach to the customer will take place.
 
Thank you,
Kelly M[redacted]

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

Hello,
Thank you
for this information.
Written
correspondence was sent to the customer on January 29, 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:
The claim has not been paid for the removal of the tooth and it will be four to six months before the implant can be done and that claim has not been filed or paid yet by cigna. If this complaint is closed then cigna may not pay the claims. I am rqestesting this complaint remain open until All  claims are paid.  The implant has not even been completed yet as the gums have to heal prior to doing the implant.
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:They cancelled my prescription for a controlled substance zolpidem 10mg tabs. My Doctor has faxed twice. Cigna has denied this, but they did it with my other prescriptions.  My Doctor will not write me anymore prescription for 6 months.  Cigna has put me in a situation where my Doctor has put me in the middle.  Will not use Cigna ever again. I will just go to my local drug store. 
Regards,
[redacted]

Hello-
Cigna has reviewed and addressed this complaint...

and the outcome directly with the customer. If the customer wishes to have the results of this review shared with the Revdex.com the attached Authorization for Disclosure of Protected Health Information form needs to be completed and returned to Cigna. Thank you
Tanya H[redacted]

Response and payment sent to the customer previousl. thank you

Acknowledgement letter with disclosure form sent to customer on April 5, 2017.  I have attached a copy of the disclosure form also.

February 3, 2014
Dear **. [redacted]:
We are writing in response to your correspondence dated January 30, 2014, regarding **. [redacted]’s claim for Short Term Disability (STD) benefits. She was covered under her employer provided, self - funded STD plan [redacted]...

[redacted], which was administered by [redacted] ([redacted]).
In her letter, **. [redacted] expressed concern regarding [redacted]’s adverse determination for ongoing STD benefits and lack of communication during the handling of her claim. We appreciate the opportunity to explain [redacted]’s decision and address her concerns.
On November 11, 2013, we received **. [redacted]’s claim for STD benefits. Based on our initial review of her medical records, her claim was initially approved for the period of November 11, 2013 through December 4, 2013. For ongoing benefits to continue, we needed to assess how **. [redacted]’s ongoing medical condition impacted her ability to function, and whether it continued to prevent her ability to return to work. For this purpose, we followed up with her treating physician to monitor her progress.
On December 11, 2013, we received **. [redacted]’s medical records. The information received consisted of an office visit note dated December 4, 2013. This information was reviewed by a [redacted] Nurse Case Manager.
The review noted that the medical information did not provide sufficient details to measure the severity of **. [redacted]’s ongoing condition or how it was impacting her ability to function and perform her work duties beyond December 4, 2013. Specifically, there were no clinical or observed findings documented, other than her reports of back and knee pain, demonstrating a severe functional impairment. Based on this information, and the review of her file as whole, we determined that the information provided did not substantiate an ongoing Disability beyond December 4, 2013, and her claim was closed.
Regarding the lack of communication, we would like to clarify our contact timeline. On November 13, 2013, we reached out to **. [redacted] to conduct the initial STD interview. However, we were unable to reach her. According to an automated message, her voice mail was not set up and we were unable to leave a message. On this same date we mailed out a letter acknowledging the receipt of her claim. On November 18, 2013, we reached out to **. [redacted] again. During the conversation she confirmed her treating physicians and we informed her that we would be requesting medical information on her behalf. On December 5, 2013, we received a voicemail from **. [redacted] indicating she would be off work until her next doctor’s appointment.
On this same day we returned **. [redacted]’s phone call and left her a message requesting a call back to discuss her claim. On December 10, 2013, we contacted **. [redacted] and notified her of the claim approval. We also informed her that to be eligible for ongoing benefits additional medical information would be requested on her behalf. On January 03, 2013, we reached out to inform her of our adverse determination for ongoing benefits. However, we were unable to reach her. On January 9, 2013, we successfully contacted **. [redacted] and informed her of our decision. In addition, we offered assistance with the appeal process.
Subsequent to our decision, on January 23, 2014, we received **. [redacted]’s request for an administrative appeal review. As part of the appeal process, we referred her file to the Disability Appeal Team and assigned it to Appeal Specialist (AS), [redacted]., for reconsideration. Upon the completion of the appeal review, and once a decision has been rendered, we will notify **. [redacted] directly of the outcome. We appreciate **. [redacted]’s continued understanding and cooperation as we consider her eligibility for, and entitlement to, ongoing benefits under her STD plan. Should she have any questions or concerns regarding the appeal process, she may contact her AS, [redacted]., at [redacted].
We appreciate the opportunity to be of service and hope that the information provided is helpful to you.
Should you have any further questions or concerns, please do not hesitate to contact our office.
Sincerely,

[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.  Claims paid. 
Regards,
[redacted]

Thank you for forwarding this complaint to Cigna. Cigna has reveiwed this complaint and a resolution letter has been sent to tothe customer on June 30, 2016. Rae B[redacted]Executive Office Advocacy Team

I have been advised that a response will be faxed to the Revdex.com by the Group Life Unit of Cigna today.