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Denied $10, 779.00 for covered services.
Posted by on
Rating: 2/51
NEW JERSEY -- On 11/24/2009 I had a medical procedure that amounted to $10,779.00. I was informed that this procedure was covered my Cigna insurance. On 01/27/2009, the service provide send me a latter tat was addressed to an incorrect mailing address. The letter stated the Cigna send a notice to the provider on 12/18/09 that they are not obligated to pay any portion of the claim because of the provider's wavier of co-insurance and deductible.

For years, this provider had wave co-insurance and deductibles and was notified of the Cigna change after my service were provided.

About 2 months ago, I was contacted by a collection agency demanding payment of $10,779.00. I called Cigna on 6/23/12 and was informed that it appeared that the claim was denied incorrectly and was schedule to be re-opened and to call back in about 15 days. On 7/5/12, I did a follow-up call and was informed that the claim was being reviewed. On 7/23/12, I called again and was informed that claim was active and call back in 15 days. on 8/8/12 I placed another call and was informed that a service representative call and informed me that I would have to file an appeal due to the claim is now over 2 years old. I am now appealing the claim and awaiting disposition.

Meanwhile, debt collection company is now calling and for payment. I am trying to hold the off because I am on fixed income and no means to repay $10,779.00 to repay this amount..Now they are possible reporting this on my credit file and at 68 I may have to file bankruptcy to get out of the debt.

     
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madconsumer on 2012-08-08:
some procedures require pre-approval. this is one aspect of cigna that is annoying. I understand if there is no pre-approval, they can deny and not pay the claim.
Kris10 on 2012-08-08:
send a letter to the debt collection agency asking telling them to stop contacting you. Also, send a letter to your state's insurance commission/department and ask for resolution to this. At the very least, it will light a fire under Cigna's butt to get a move on with your appeal.
trmn8r on 2012-08-08:
I can't follow all the lingo in the letter, but hopefully Cigna will get this resolved. It's too bad you have to deal with the collection agency in the meantime.
CowboyFan on 2012-08-08:
What was obviously happening was that out-of-network doctors were charging patients more, then waiving the co-insurance and deductible on that amount, so that in effect CIGNA paid the entire cost of the bill, e.g. $10,000 normal cost of procedure-patient to pay 20% ($2,000): instead doctor inflates bill to $12,500-waives the 20% from patient ($2,500) and then collects $10,000 from CIGNA. Doctor gets paid full amount, patient pays nothing, CIGNA gets stuck paying an extra $2,000 it should not have to.

Now CIGNA says that patients must pay their share of the total, or none of the bill is to be paid by CIGNA. Since the bill will be paid if the patient pays his deductible/co-pay, the solution would seem to be for the OP to go back to the doctor, pay her doctor the co-pay and deductible amounts, and then have the doctor resubmit it showing that these have not been waived. Then CIGNA would pay their portion of the bill which the patient has not paid. The op paying part of the bill would be cheaper than paying all of the bill.
Anonymous on 2012-08-08:
Why did the provider wait so long to do anything? If they had done all this 2 and a half years ago, then maybe Cigna could have done something. Insurance companies usually have a time frame for re-considerations for claims.
olie on 2012-08-09:
Cowboy Fan, you explained this well.
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Warning If You Have A Choice; Don’t Use Cigna For Your Fsa!!!
Posted by on
Rating: 1/51
EDEN PRAIRIE, MINNESOTA -- I am not aware if CIGNA provides FSA management for other companies, but as a CIGNA employee spouse I am appalled at the lack of communication and the frustration of processing a request for reimbursement from my Flexible Spending Account.

I had $2500 from my FSA for 2013, my son had orthodon'tia on 12/31/13. This is a qualifying expense for the year 2013. I waited for the processing of my dual dental coverage, but there continued to processing issues. I could no longer wait to file my request for reimbursement as the deadline for submission had approached. I submitted the information I had indicating payment to the Orthodon'tist of $2475 and an EOB from a dental insurer indicating treatment began in December 2013.

CIGNA’s explanation of eligible orthodon'tia services being reimbursable clearly indicates that “reimbursement can be made once charges have been billed. This can be a one time fee less any amount paid…” The total billed for orthodon'tia is approximately $6000, I have paid a portion and dental insurance will eventually pay the rest. NO WHERE does it indicate that FSA will be reimbursed to the member / client / customer based on date paid.

Per the IRS Orthodon'tia is an eligible medical expense. And “distributions from a health FSA must be paid only to reimburse you for qualified medical expenses you incurred during the period of coverage.” The period of coverage for my service was 2013.

STOP WITHHOLDING MY MONEY!! The FSA has a use-it-or-loose-it policy and a dollar limit, so that people don’t shelter income tax-free. The other advantage people have to use a FSA is access to the money for qualified expenses during the plan year before they have contributed all the earmarked funds. BUT CIGNA is not accountable – I am accountable to the IRS, so GIVE ME MY MONEY!

ORTHODONTIA is not special – it may be paid differently when processing it a s a dental claim – BUT CIGNA YOU ARE NOT PROCESSING A CLAIM FOR PAYMENT TO A PROVIDER! This is my money; this was my qualified medical expense during my qualified plan year. There is nothing more to process.
     
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LesPerks
Posted by on
Rating: 2/51
WESTON -- 09/12/2013

This medical-management and Medicare affiliate. company offers many nice amenities, free exercise work-out facility access, transportation to medical-dental appointments and a small monthly allowance for OTC (over-the counter) medications and left-over dollars roll-over each month.. This all sounds good and looks good on an advertisement. This is a good draw for retired and disabled persons living on fixed incomes of just a thousand dollars or less per month. We manage but there's not much left over for extras.

The problem is, mainly with transportation and customer services' ability to resolve an issue. We need transportation to get to and from appointments. No-shows and being late is a consummate problem. Customer service personnel are surly, argumentative. Many, disrespectfully, presume first names when addressing their patrons. They hang-up on you. They make a, relatively, easy encounter stressful.
My daughter, uses a wheel-chair, was refused transportation because she, allegedly, had used up her transport quota.

Our agent was incredulous to explain this mis-information. He made a call to customer service said we would get a call. I got a voice-mail. We returned the call. We left a message with a live person but never heard from this person. Our agent followed-up to see what happened? We told him we were filing a grievance.

On a call to customer service, I recognized her voice and her name but she, totally, denied any knowledge of having tried to contact me. It was her. Go figure. Right? We mailed a grievance around June 2013. One person left a voice-mail, 09/04@9:20 am. Nine days later after (4) return calls to her voice-mail we've received no further response.
OTC? About 8:30 am, 09-11-2013, I was hung-up on (3) times on (3) separate calls by (3) separate clerks before, on the 4th attempt I got a clerk capable and willing to dispense week later I called to inquire, as my meds had not arrived. The insurance clerk gave me a postal tracking number and told me to call my local post office. I did. They told me the package was there and it would be delivered in a few days. About, 08/15/2013, a clerk told me it was their ((Cigna) responsibility to track the order and she did telling me the items were at the post office and would arrive, shortly. I left for vacation from 8/21-8/28.

The meds had not arrived. On, 08 /29 I called again asking for a supervisor. This person apologized for the confusion. My item arrived about, 09/03. I called (Cigna) and, actually, got the same guy who, originally, placed the order. He tried to give me the track number again. I refused telling him that was his job not mine. I suggested that he cancel the order and submit a new order, as the delivery time had surpassed its allotted time. I asked, why, who at Cigna had diverted the original order from UPS to the local post office? And, why, were their personnel instructing clients to track packages?
     
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Cigna Medicare Access (PFFS) 2010
Posted by on
P.O. BOX 696018, TEXAS -- BEWARE!!! SENIORS OR ELIGIBLE MEDICARE RECIEPIENTS!!!! CHECK MEDICARE VS. ADVANTAGE, REPLACEMENT PLANS BEFORE YOU SIGN UP!!! THEY WILL OFFER YOU "FLUFF’S," AND YOU WILL PAY MORE OUT OF POCKET THAN ORIGINAL MEDICARE!!! Cigna's Medicare Access Plan (PFFS) 2010 does not pay for some medications that have to be administered by a physician in their office. Cigna states that the medication (medical Botox) has to go through their Part B; they gave me the run-around. I have been told more than 4++ (I lost count) different excuses from Cigna. Here is their latest "Mumbo Jumble" that was stated by a company representative (SUPERVISOR) in Arizona: "Yes, we do cover the ADMINISTRATION of medically necessary medications MEDICARE PART B-but, you must meet your $3,000 deductible; any and all the co-payments that you have made throughout the year do not count." I reminded that their contract stated that an individual on their plan is only responsible for a $20.00 co-payment for a specialist MAXIUM. Then, "Marge" stated that Part B was separate from a regular office visit for the administration of the drug. CIGNA insisted that I had to get this drug from their pharmacy (covered under "Argis-I am guessing their preferred drug company ‘Medco’ uses this pharmacy.”) First, Cigna's Part D called and told me I would have to pay $241.00 out of pocket. Then, they called back and stated that the cost would be $999.60 out of pocket. Again, Cigna called and stated that the drug would cost $940.00 out of pocket. "Marge" called and stated that she could get the drug for $760.00, but....I still did not meet my $3,000 out of pocket for the neurologist, so, I would have to pay for the drug and an out-of-pocket expense for the doctor to administer it (they told the Botox Assistance Programs that they were going to pay for it). I called Medicare; they told me that if I had regular Medicare after I met Part B deductible, that my cost would only be 20%. Medicare stated that these replacement, access, etc. could make up their own rules without government regulations. Now, I had to reschedule my appointment for December 21st, 2010 until after the January 1st+++, 2011, when regular Medicare kicks in. I am in so much pain that it is difficult lying in bed to type this. My neck, face, jaw, and eyelids are in painful spasms. I have had surgeries, pain management without any relief. I am a disabled RN due to a patient assault. I thought Cigna was a good company; I should have googled them instead of trusting them prior to signing up with them (I was ill when I signed up with them, and I was not thinking properly due to serotonin toxicity). As a nurse (although disabled), I believe it is my duty to warn our senior population and disabled individuals, so that they do not end up paying more out of pocket expenses that regular Medicare. (Please note: I paid CIGNA $95.00 monthly + Medicare Part B premiums + co-payments; this equals-MORE than REGULAR MEDICARE.
     
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Deliberate Obstacles to Health-Care Benefits
Posted by on
11095 VIKING DR., SUITE 350, EDEN PRAIRIE, MINNESOTA -- I am dropping Cigna as soon as I can because its service has been appalling. I have been submitting claims since February 2010 and never once have I received the amount of reimbursement that I was promised (70% of Reasonable and Customary for an LCSW in 20912=105 out of 150); it was solely on the basis of that promise that I chose Cigna.
I could not make up the nightmare this company has been. I have met every possible roadblock: one claim was denied based on my mistake of copying the diagnosis code incorrectly from my provider’s itemized bill to my itemized bill—BOTH itemizations were included with the claim, however. I have been repeatedly denied full reimbursement (70% of reasonable and customary for out of network) because initially my provider was in an affiliated network, without knowing that that was still active (or that that affiliation with Cigna even existed). He has since TWICE provided documentation that his association with that affiliated network was ended AS OF 1 March 2010, and still, as of this date, I am being told that Cigna has no record of this change having been made. I have had to call twice monthly and each time explain the entire situation because apparently no record is made of my calls.
I am convinced that Cigna is deliberately blocking my access to reimbursement, and thus to ongoing health care provision, in order to frustrate me out of pursuing my claim. I will not only not renew my policy with Cigna, but I will tell all my family and friends and everyone else I meet that Cigna is just a typical Insurance company whose SOLE concern is its own profit, and who is willing to sacrifice anyone’s health and well-being to its bottom line. I will also continue advocating for socialized medicine and the abolition of all such companies as Cigna. The only recourse the U.S. has to such abuses is to nationalize health care and place limits on the unprinicled actions of those who believe that capitalism is an ethical system entitling them to exploit and abuse those who have physical and mental illnesses.
     
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Anonymous on 2010-08-20:
I, too, have had problems with Cigna this year with things that just should have been paid--and have been in the past. After appealing, they relented on one claim. On another, they kept denying, so I ended up just paying the $60. I think that's what they want us to do all the time. That saves them from paying. Just imagine if they do this to all of their policy holders. That's quite a sum of money they're saving.

We pay a huge premium for this coverage, which is provided by my husband's employer. I am sure we never have enough claims to even cover one month of our premiums either. I don't know what the answer is, but I agree that a change is needed.
skelly39 on 2010-08-20:
Contact the Dept of Insurance in your state and file a complaint.
E-Squared on 2011-01-18:
Here we go again. Cigna is denying my Rx payment, claiming they need more info. from my doctor's office. Granted, it's an expensive medication but then, that's why we buy insurance, right? I submitted the Rx to the pharmacy over one week ago and have talked to a Cigna rep. once since then, and now I find out they just yesterday (8 days now) faxed the form to my doctor's office. They also tell me that they have 2-4 days AFTER they receive the form from my doctor to approve the Rx. It'll be well over 2 weeks before this whole thing is over. Not a bad scheme - - if they can get away doing that twice a year, they save themselves at least one months worth of payments. Not bad work when you can get it, eh?
rir122 on 2011-01-20:
I used to work for Cigna Healthcare I was a CSR, I used to handle the inbound customer calls. Trust me when I say that they have records of your calls. They have to document ever thing that they are told.

They have a program named Impact that is used just for documenting these calls. If you have ever called Cigna they have a record of it word for word.

Even if you just asked for a phone number to a doctor they have to keep a record of the call. They even keep track of wrong number calls and people who just hang up without speaking. Also they record all the phone calls; they used to play us back transcripts of the conversations.

Anywho they have their CSRs bury that information. I used to do it everyday that is their main responsibility.

I would get calls from people who called mulitple times about a claim they submitted a while ago; sometimes years before the date they talked to me.Because there was no payment made on their claim.

I would then log into Impact; only to find that the member has called multiple times and was told multiple times that there claim was being processed or it hasn't been received. Then I would log into another database where they house the claims "Docs" (as they call it) to find that so called missing claim was sitting there untouched!

You would be surprised how many people I have told we didn't receive their claims when in actuality we did and just didn't pay it.

There were times when I had members who sent their claim multiple times; and we had multiple copies of it. But we where told to tell them to send it in again.

I remember this one lady who had a claim for $25,000 for a surgery she had in 2007. She called 9 times; we had 6 copies of her claim but my analyst Rick told me to tell her we didn't receive it. I was instructed to have her resubmit a claim I was already looking at.

Cigna teaches its CSR's to bury that stuff, I know it sounds like I'm exaggerating but it is true I used to do it.

They would tell us to take ownership of the mistakes previously made by other CSRs. So if you looked in Impact and you saw where someones claim wasn't processed properly; you where supposed to make it seem as if it was the first you ever heard of the situation.

Cigna only cares about the claims of the executives that are insured with them. The Vice president and higher ups of the company will get there claims processed but everyone else has to wait until Cigna feels like paying them which is usually never.

Cigna doesn't tell you this but they put each group in different categories. Your company all has the same insurance provider but different levels of coverage.

Like A,B,C,D they classify it by the pay scale of the employee. You don't even know what class your in nor will you ever! CSRs are told not to mention to the members that there are different levels of coverage. They use that as a scale of whether or not your important enough to them to pay you. The higher up in class you are the better chances of your claims getting paid.

If I had a member who was Class A on a plan he was probably an executive and there claims pay more often than not. Also the higher your class the better overall plan you get.

Cigna knows that if they can keep the high ups who make the decisions happy by paying their claims that that company will stay will them.

The executives know that they have better coverage but they don't know that their workers have such poor coverage. Sometimes executives would call in on behalf of their employees when problems would arise. It's amazing how much of a difference being an executive can make.

Cigna says that the "C" in Cigna stands for Care that's what they tell the customers, Insiders know that the "C" really stands for change! That's because Cigna changes their S.O.P's so much; that you literally have to check it on every call; just make sure that something that was covered yesterday is still covered today.

Example During training we where told that Out patient procedures did not require pre requisite at all. Well Cigna changed their mind one day and decided that a Pre requisite was needed depending on the state you where in.

I hated working there and most of the people who work there are miserable its a sad place to be. You have no idea how bad you feel when your on the phone with someone who pays their premium but can't get covered because of some B.S. rules

We actually had some CSRs sitting on the phone with people who were dying literally dying at that moment and they couldn't get cleared to go to the hospital even though they paid their premiums.

A friend of mine once sat on the phone with a guy who was in the middle of gunfire in Iraq. He wasn't a solider he was over there working for his company. He had repatriation coverage which would send someone to go get him out of there; in the case of an emergency. But the catch was he had to be injured first.

My friend had to sit on the phone with this guy until he got wounded; before she could call for help to get him out of there. Our supervisor was sitting right there while this was going on. He couldn't do anything about it that was the way the coverage worked.

Cigna doesn't give a damn about its policy holders they only care about getting their premiums.
Emily on 2011-11-07:
Thank you for sharing this info. I wish that everyone in Congress was reading this email now.
Zooey on 2012-06-25:
Reading this literally made me sick to my stomach. After 6 calls to Cigna repeatedly being told they have my "docs" and they will be resubmitted, I was finally told today that they actually don't have my "docs" and they have no recode of them either... Do I have any legal options here? This is plain obstructionist of Cigna.
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CIGNA: Using your private medical information
Posted by on
EDEN PRAIRIE, MINNESOTA -- I'm have been on Cigna as insurance for 8 months. I have been with the same therapist for many years, using the insurance plans offered through the companies I've worked for. I suffer from mild depression and working with a therapist has helped my quality of life immensely. I recently received something in the mail from Cigna. A letter that begins: "Have you recently experienced trouble concentrating or sleeping? Are you feeling overwhelmed, anxious or withdrawn, or having difficulty adjusting to a major life change? Did you know there's a free service through your medical benefits that can help you manage your symptoms? Recently, a claim we received from either your doctor or pharmacy, or information from a health assessment you completed, has helped us identify you as someone who may benefit from this program."

I am feeling completely violated by this. I have never had an insurance company feel they were entitled to step in and comment on my private health information or assume they were qualified to inject one of their staff into my life to comment on personal health issues. It's like a new level of intrusion. How could this possibly be in compliance with HIPAA?

My expectation is that an insurance company can approve or deny claims, not that they can administer care or provide health care advice. Cigna has taken my health care information--either privileged information that I share with my doctor or specifics of medications that I have been prescribed, and run it through a marketing program that would identify me as someone they could put into a bucket for solicitation about a mental health "coaching product" they offer.

I'll be taking this up with my doctor as well as the attorney general about privacy and legality. I can't just let this end with Cigna pushing the envelope with methods that are intended to intimidate patients into ending medical care that is of a highly private nature. I'm sure it would be quite convenient if Cigna could get me to end my therapy with a qualified physician with whom I've been working for years, and call their free "phone coach" for therapy instead, but this is totally unacceptable to me.

I don't want Cigna to monitor my private health care and diagnoses and offer me tailored marketing based on their business objectives. I pay my premiums, percentages and copays and am entitled to proper medical care. So I have two choices: 1. End my care so that they no longer have access to my private health care information and diagnoses, or 2. Fight back and tell Cigna that I don't want them using my private health care information and diagnoses for anything other than a yes/no vote in their claims system. Knowing that my disapproval with their policy won't be enough to bring about change, I have no choice but to bring this issue to a wider audience.
     
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DCGirl on 2010-07-10:
HIPAA does not mean that all medical information must be kept private in all circumstances, despite the widely prevailing belief to the contrary. You may want to review this link at the Department of Health and Human Services HIPAA FAQs titled "May covered entities use information regarding specific clinical conditions of individuals in order to communicate about products or services for such conditions without a prior authorization?"

http://www.hhs.gov/ocr/privacy/hipaa/faq/marketing/292.html

Seattle1 on 2010-07-11:
Thanks for the link. I'll read it over before sending my letters and talking to my doctor. If HIPAA doesn't protect us then I guess I'll have to appeal on another level. My primary issue is that an insurance company is trying to intimidate me into discontinuing medical care by letting me know that they are using my private medical information for reasons other than making yes/no decisions in my claims--and these are very basic claims. This felt like getting a letter saying "Hey- we read your files and noticed that you have a sexually transmitted disease. If you are promiscuous or immoral or have some other messed up issue--you should call us so one of our customer service agents can talk you out of whatever it is you are doing that has caused you to seek medical treatment." It's inappropriate on so many levels I don't even know where to start.
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Cigna Sham--Disability Buyers Beware! You Are Not Protected
Posted by on
LOCKHEED MARTIN CORPORATION -- Where to even begin.

I have been fighting Cigna for 4 long years regarding my short and longterm disability insurance.

Like others who have testified on this site, my benefits were abruptly shut off and then I experienced a continual denial on each appeal for various different reasons starting with "We don't doubt that you have suffered from various medical problems, but believe they do not constitute total disability" to that of a "preexisting condition". Cigna utilizes an in-house nurse to rubber stamp rejections as their supposed medical review process.

I suffer from Interstitial Cystitis, Fibromyaglia, Depression, IBS, Degenerative Back Disease, Vulvoldynia, and Migraine Headaches. My medical records contain letters from 4 different urologists that state I must undergo longterm narcotic theraphy for chronic pain due to an incurable disease which causes intractable pain. My pain management doctor has attested to my inability in maintaining employment due to both physical and physcological limitations.

Like others on this site have stated prior to my review, Cigna ignored my doctors reports and medical records which declared me disabled. They also ignored the fact that the Social Security declared me disabled and incapable of any performing any occupation. In addition, Cigna has never even requested a physical examination performed on me by a doctor of their choice.

I appealed Cigna's denial decision to the State Medical Board. The State Medical Board required Cigna to have an "outside" (Cigna paid) medical doctor review my case. Cigna's doctor reviewed my medical records. There is no surprise that he denied my claim. The doctor was blatantly unfamiliar with my primary disease (IC), and he could not even read my diagnosis reports. The State Medical Board could not require Cigna to pay my claim, and they suggested that I hire a lawyer and take legal action against Cigna.

I hired an attorney who works on a 40% retainer with $400 down. At this point, Cigna came through with a chump change settlement offer which I declined. Cigna only offered to pay my entire claim/policy off for just 2 years of payments which would constitute the lookback period of whether I can work "any occupation". The case is now in court awaiting the judges decision.

According to the policy, the question to the court now is not whether I am disabled, but whether Cigna's administrator was "arbitrary and capricous" in making their denial decision. Of course they were "arbitrary and capricious" in their decision. but this is huge hurdle to prove and really irrelevant, I am disabled and deserve my money.

From reading comments made on the reviews posted, the majority of people do not understand their employers disability policies or ERISA law. You cannot sue for or collect punitive damages (pain, suffering, mental anguish) against the insurance company. You may only collect what is due to you under the policy adjusted for cost of living and interest. That includes the fact that I cannot recoup my doctor and prescription costs which I paid out of pocket during the 4 years that my insurance and prescription benefits were also denied. With all this being so, there is absolutely NO incentive for Cigna to pay ANY claim.

WARNING: Therefore, it is best NOT to pay for disability insurance through your employer (which falls under ERISA laws), but protect yourself and family by buying outside independent insurance. Paying through your employer is just flushing good money down the drain. DON'T DO IT.

At this time, I am hoping for a favorable ruling from the court. If so, as I state above I will be out 40% to the lawyer and will not recoup any out of pocket doctor's office or prescription expenses occurred over the past 4 years.

My lawyer has informed me that if we Win the case he expects Cigna to appeal. My lawyer has also told me that if Cigna appeals he will not continue to work the case on a contingency basis but need upfront payment.

This entire process of dealing with Cigna has been a nightmare. I have exhausted my 401K in medical bills and living expenses.

FYI-God forbid that you should ever find yourself in a similar situation. If so, my best advice is to ask for a copy and review your disability file from Cigna regularly. Make this request in writing sent certified. You will find that Cigna purposely ommits information that bolsters you case, and Cigna purposely inserts information that makes you appear unavailable and unresponsive to their requests.

This employer insurance is a SHAM and need serious reform. I am at a loss as to why this is not covered in detail by the media and news programs. Someone somewhere is making BIG money and must be paying others to keep hush.

You have now been warned. Consider yourself lucky and protect yourself and your family appropriately.







     
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Skye on 2009-06-28:
Excuse me, but what does Cigna have to do with your disability?? I thought disability was paid out through the social security disability insurance.
whiteon on 2009-06-28:
I paid for both shortterm and longterm disability through my Employer. Cigna is the carrier. This is private insurance. It is a policy where 60% of my salary is covered. If disabled Cigna pays this amount. Since I have been awarded Social Security disability payments, Cigna would deduct the amount of SS payments from their payment and owe me the difference.
Suusan B. on 2009-06-29:
Thanks for the follow-up information as it makes your situation more clear. One of the most difficult things in the world is to get Social Security to deem a person permanently disabled and it does sound like Cigna is blocking your claim which stinks. You are basically sold this insurance coverage by your employer and faithfully pay for it each month but now that you need to "cash in" on what you paid for Cigna won't pay. Good luck.
whiteon on 2009-07-01:
Suusan B.

You are so right. Dealing with Social Security was a nightmare, but it was NOTHING compared to dealing with ruthless Cigna and their insensitive robot employees. I don't know how these people can even sleep at night. I certainly could not hold a job that I knew was a sham and detrimental to the healthcare of others.

Thanks for your post and your support. I am trying to patiently await the courts decision.
anklebiter58 on 2009-07-21:
I've just had my short term disability claim denied/cut-off by Cigna. I had my 3rd cervical fusion surgery on March 6, 2009, which left me with a four level fusion. The reason for this surgery was a very large disc at C3/4 that was ruptured into my spinal cord. Before and after the surgery, I suffered with quadriparesis. Because of the weakness and pain in my arms and legs, and the inability to turn my head right, left, up or down very far without a lot of pain, I have not been able to return to work since my surgery. I also had a disc at L5/S1 rupture 2 weeks before the surgery and has caused sciatica and severe pain down both hips and legs. I am not able to sit, stand, walk,or even lay down for more than a few minutes at a time. On top of this, I already had fibromyalgia and chronic hip bursitis. Even though my doctors say I can't go back to work within the next 6 months, and not even then without strict restrictions, Cigna's so-called experts have denied my claim, stating "frankly, we don't see any reason why you can't work." I only got this denial after the paid me for the first 6 weeks, then stalled for the next 3 months - with claims that the doctor's office had not sent them requested information. As soon as I called them back and told them the doctor's office had sent them the information weeks ago, they lied and said, Oh, yes, we just received it yesterday, now we have to have a statement from your doctor. All just stall tactics to get to the inevitable denial. Cigna Insurance is a scam - we have short term disability and long term disability to cover us for when we can't work. I'm 50 years old and worked hard every day of my life and never had to be out like this before. Now when I need it, I am denied - no matter what my doctors say. I am frustrated and depressed. Its bad enough that I'm only 50 and walk and get up like and 80 year old, but I have to go through this humiliation with Cigna claiming my conditions are fake. It looks like it will be a hard road to ever get my money from them - but I'd like to see things change so that can't do this to other people.
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Change In Policy And Notification
Posted by on
I am a current recipient of disability benefits from Cigna. I received a call today from my representative at Cigna informing me of a policy change. I was supposedly to have received prior notification of said change -- but, of course, did not. My case is under review -- I had Cancer surgery 2 years ago and currently am being treated by a pain management specialist for chronic visceral abdominal pain syndrome. I also have systemic lupus erythmatosis, and recurrent bladder cancer. I have one kidney and have had 5 other cancer related surgeries (three abdominal, one testicular, and one for parathroid cancer. I am on so much pain medication that I can barely type this message and have sever short term memory loss. Yet I am under review again. Social Security still carries me a permanently disabled and I receive a 20% service connected disability payment for service in Vietnam. I am well educated and have worked in government scientific research since 1974. Again, Cigna gave no prior notice of a review nor was information regarding the nature of the policy change forwarded. I still don't know what exactly that change is - but I would guess they are divorcing themselves of Social Security determinations.

We have lost over half of our 401 K and I cannot interest any reputable company in refinancing our VA loan -despite the low interest rates and the streamline procedure mandated by the VA. By the way my combine credit score is 787.
Now I am to lose my only other source of income - due to a "policy change". I have had one physician refuse to treat me because according to him I am so ill that I belong in a tertiary ( hospital) treatment setting. What are we to do. I just returned from a grocery store that cheated me out of $10.00 worth of their own coupons -- due to "system failure". What recourse do we have - is America finished?? Beware -- those who served their country -- it will probably dance on your grave after starving you to death when you are physically unable to work -- by the way I was exposed to Agent Orange - and what has been done about that - a lot of verbiage and still no support for veterans who are now dying by the score due to cancer and other premature illnesses.
     
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jenjenn on 2009-02-25:
I work for an insurance company, and we send out several notifications of any plan changes at least 60 days prior to the change. (it's the law) Funny, nobody ever receives our info either. Read your mail people!
tnchuck100 on 2009-02-25:
jennjenn, would it be possible that your company sends these notifications "Presort Standard" (formerly Bulk Rate) instead of "First Class"?

If your company is using "Presort Standard" people most likely treat it as solicitation garbage. But, that probably plays into the corporate plan to slip changes by the customer unnoticed. Many companies use this tactic.
Principissa on 2009-02-25:
Our insurance company puts any notifications in with the bill. No excuse not to notice.
ToxDoc on 2009-02-25:
we read our mail even if it is so called junk mail for exactly the purposes you cite. Thanks. I still am bewildered by the things going on. I have contacted my HR person with this information and hope to hear from them soon. If I don't then I will know that I have a bigger problem than I first thought. Thanks again for the advice - although some appeared to be rather remonstrative. Regardless, I don't intend to go down without a fight as Proverbial "they" say. I would appreciate any constructive ciriticism or advice that can be tendered.
jenjenn on 2009-02-25:
It doesn't matter how the mail is sent. If it's from your insurance company, it COULD be important. (perhaps not always, but why take the chance) I know with our company several notifications are mailed out - to people personally, to the employers, and in newsletters. I love it when people tell me, "I never got that." Besides, I don't look at the postage on my mail to determine how it was sent. I scan it, if it's trash, then I toss it. (that's just me)
ToxDoc on 2009-02-26:
my profession require thorough reading of all communications then applying action if needed. the statement of the person who made the call was clear that such communication was probably not sent (there is at least one person at that orgainzation who is cocerned for their customers). the underlying issue is not clack of communication bue unilateral violation of a contracutral agreement. Ov course this corporation has a cadre of very expensive lawyers to overwhelm any individual complianant -- idt is to bad thet these funds are not used to fulfill their obilgations which they contracted in the first place . It is attitudes and actions on the part of large corporations that make their money by establishing agreements with others and then ignoring the agreement that has gotten our country into the worst financial crisis since the Depression - and this may prove to be even worse than that was. However the ramifications are larger than just unilateral violation of a contract - this economic crisis is global - and people from other countries have guns and bombs and are not afraid to use them to get what they want. We are now one of the most hated nations on earth and it is not beyond possibility that the greed and misbehavior of a few could lead to dire consequences for themselfves and those that they cheat. History is full of examples. The Roman empire, Alexander the Great's empire, Gengis Kahn, Napoleon, The British empire (a few dozen other examples ---- and now the global financial empire -- get the picture or need I say more. My plight and complaint is, of course, critical interest to me - and should be to evayone else. If you are saying to yourself not me - think again. When was the last time the lowest eschelon of you large corporation given a merit raise - do they live near the poverty line even though they may be very dedicated employees. when was the last time you got a well deserved merit raise? NO I am not advocating socialism - just good old American fair play. This mess seemes to be go be a good reason to return to a fair play ethic and to return to the reason this country was made great - that anyone can achieve commensurate to their native abilities given a level playing field.
ToxDoc on 2009-02-26:
sorry my typing is so lousy - I have arthritis in my hands and rely so much on spell check these days I fail to edit these messates properly before posting - enough is enough I made my point - luck to you all no more comments - thanks again.
cherpep on 2009-02-26:
I always read my bills, and check the so-called junk mail for important notices. But, it does occur at times that I do not receive something that a company claims was mailed to me. I repeat - I check EVERY piece of mail. I just LOVE it when I call that company and get that sigh on the other end of the line that is followed by the condescending comments.

Sorry, I don't have any advice for you, ToxDoc, I just wanted you to know that there is someone out here who believes it's possible to NOT receive something from the mail. You have my sympathies for your situation, I truly hope you are able to find some assistance.
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Do Not Buy Insurance Coverage From This Company
Posted by on
PORTLAND, OREGON -- I got Cigna through my husband's work. This is the first time I have Cigna. The coverage said that they cover acupuncture. Since my cancer treatment, I had many pains on my body. I had tried physical therapy many times, but it doesn't seems to work. Since my Cigna insurance cover acupuncture, I decided to try it with my doctor permission. I picked a acupuncture doctor through the network, cause I don't want to have any problem on denial of my treatments. After a few treatments, I felt better. My neck was able to move better and shoulder not so tight. My back pain was almost gone. I felt so much better emotionally and physically.

Then, my acupuncture doctor told me that Cigna was not paying him. When I called, they told me, they denied the coverage, cause I didn't call them for permission to go see a acupuncture. In my entire life, I have never experienced this before. If my insurance coverage said they will cover acupuncture with my family doctor's permission, than, this should be covered. I even picked a doctor under their network, hopefully this way will have not problem, but Cigna, just finds ways to not pay their coverages. What kind of insurance company is this? My husband paid for our insurance coverage every month through his pay check, so we won't have to worry about paying so much when we need to go see a doctor. Cigna has fail to do that for their clients. Because Cigna had rejected to pay for my acupuncture bills, now I had to stop my treatments. My neck, shoulder and back pain have came back. Due to this experience, we will not buy Cigna again next year. I will encourage whoever out there trying to look for a health insurance coverage, make sure you do not pick Cigna Corporation. You do not want to deal this kind of situation like me.

P.S. I will research this kind of practice about Cigna. I believe, this kind of company practice is totally wrong. May be a big cost of lawsuit will get them understand the basic moral of human nature.
     
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jenjenn on 2008-12-01:
If acupuncuture is clearly covered under your policy, and the correct steps were taken to get the highest benefit level, you should submit a letter of appeal (to Cigna) to get the services covered. You usually have 180 days from the time the claim was originally denied. If this does not produce results, contact the Bureau of Insurance in the state in which you live.
Anonymous on 2008-12-01:
I have a little bit of experience with insurance, but I am not familiar with Cigna's processes. I can tell you that with the company I work for now, specialty services such as acupuncture are an in-network covered benefit IF the primary care physican believes the therapy is medically necessary. If that is the doctors opinion then a request for authorization is submitted and then you will be covered for treatment. IMO it is a lot of unnecessary paperwork, but that is the way that it is. I think if you read your benefits handbook it will state the same things that I have said here. If your handbook does not specifically state that authorization must be obtained in advance, I would appeal the denial. If they still do not pay I would submit your informatoin to your states department of insurance to investigate and ask them to overturn the denial of payment.
yoke on 2008-12-01:
We have CIGNA now. It sounds as if they need prior authorization which they did not get. Just because the doctor suggests it, it does not mean it will be covered. The acupunture doctor should have verified the authorization before they started to work on you. It took us about 3 weeks to get an authorization for a surgery for my son this past summer.
Anonymous on 2008-12-01:
See, Yoke! That's what I said. :) I feel validated.
yoke on 2008-12-02:
John, a lot of people think they can go to any doctor in the directory without authorization and then get upset when it is denied. I blame the acupincture doctor in this case since he treated her without the authorization he needed. His office staff should have known to get prior authorization. That is their job.
Anonymous on 2008-12-02:
You are absolutely right, Yoke. The office should have gotten as much information over the phone as possible so the insurance issues could be dealt with before the patients appointment. When it comes to health benefits we should all ask as many questions as possible. Don't just find out what your share of cost will be... that's just the tip of the iceberg. Find out what is covered, if not, does the procedure require prior authorization or is it a benefit exclusion (there is a difference). Be prepared so when we are confronted with a situation like this we have the information we need. It's also good to know this information so if you don't like your current health coverage you will be prepared during your next open enrollment.
joshvhawaii on 2009-12-19:
Have you heard of an HMO?
Blessedintx on 2010-03-10:
I am new here, so be patient with me please. I think my situation is a little different. My Bariatric Surgeons office called Cigna (I have Open Access Plus) and was told by a Cigna Rep that bariatric surgery was a covered benefit , that I had to go to 6 months of nutrition, behavioral and exercise lecture classes, I had to do several things , like a psych eval, an EGD upper GI test, sleep study etc. I have done it all, Paid out ove $500 in copays, Cigna has paid out over $7000 for all of this and when the doctor's office called to get the final precertification by submitting all the records that we had followed the required course, they were told that their rep made a mistake. This surgery is not covered. Sorry, really too bad, but we don't pay for any type of bariatric treatment. BUT they have paid over the last 6 months for tests and classes by a Bariatric Surgeon. I don't get it...who's screwing with me Cigna or Dr office?? Thinking of talking to my lawyer. Any insight or advice is appreciated!
I am just devastated. My new life I have been working towards, the one were I could get more mobile, be healthier, enjoy my family, enjoy LIFE has just drifted away like a mirage...
Anonymous on 2010-03-10:
Blessed, what happened to you is immoral. You were told the procedure is covered. 6 months of you working towards your goal. 6 months of Cigna paying, which would lead you to believe the procedure is covered. Then one day, poof. You've been done a huge disservice. I do agree you should call a lawyer.
MarlyB on 2010-04-08:
You have to obtain prior authorization for certain services, it says on the back of your card. your Md should have know that. Especially if he is contracted with Cigna.
Word of advice, if he is a contracted MD with cigna, and they fail to precert your procedures, they are responsible.. not you. It's in their contract.
Carola3173 on 2010-05-26:
Great article, 5 STARS
It is very important for everyone to have health insurance.If you don't have insurance and you have to go to hospital, you'll have to pay over $20,000.That happened to a friend of mine.I know a site that offer the cheapest possible price for health insurance, free quotes and a lot of benefits.

NationalHealthInsurance . info
Sheriffs Uncle on 2010-05-26:
Carola, Indigents with no money can't and don't pay $20,000. The people that need health insurance are the people that have something to lose if they get sick, which is most people. Your figure of $20,000 is just a made up figure. If you go to the emergency room, and are released without being admitted, your bill will probably be a whole lot less than $20,000. Did you sign up here today to sell people insurance?
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Cigna Tel-drug Idiocy Accidental Or On Purpose
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HOUSTON, TEXAS -- My first experience with Cigna has thus far created three problems.

1. Upon receiving 5 prescriptions from my doctor they first canceled the order because they "could not reach my doctor for verification". I was not notified by them and continued to wait for my prescriptions in the mail. It was only when I looked on-line that I found out that the order was canceled. When I called them they said were unable to reach my doctor and get approval. I told them to try again and they called back to tell me they had received approval.

2. After waiting another 2 weeks for my mail order prescriptions I checked on-line again. Only the cancellation was shown. When I called them they said they could not fill one of the prescriptions because my illness (CFS)was not among those listed for this medicine. The medicine is an antiviral drug, and what I have is a virus, but Tel-drug determined it was therefore an experimental drug and "they do not cover experimental drugs". This drug has been around for about 100 years and I have been taking it for 20 years. I don't know of ANY medication specifically for CFS. The written notification said that they would not fill that prescription because they were "unable to obtain authorization to fill my prescription". However, it was not my doctor who refused authorization, it was a pharmacist at Tel-drug. I asked if it was common practice for them to cancel all of a person's prescriptions because one could not be filled. The Tel-Drug representative had no answer. After five phone calls four of the five medications were delivered.

3. During this pharmaceutical hell, they had asked for how I would pay for the drugs. I gave them credit card information and my statement showed the payment to Tel-Drug on August 11. I then received a statement from Tel-drug dated September 3 showing the amount as unpaid. When I called today and told them the charge had been made nearly a month earlier on my credit card, they said they had no record of receiving payment and I need to mail the credit card statement to them. So thanks to I do not have my main medicine and they do not show payment for the others so grudgingly filled.
     
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