, MISSOURI -- My husband has Cigna Health Insurance through work. In January 2013 he was diagnosed with Cardio Myopathy, and was told by his cardiologist that he would need an Internal Cardiac Defibrillator implanted. Due to a lot of Medicare fraud with these devices, the government has a 90-day MANDATORY waiting period before one can be implanted, during which time the doctor monitors to see if medication alone can help the condition. During that waiting period, most of these patients are prescribed by their cardiologist to wear a ZOLL Life Vest, which is an external vest worn that can shock the heart in case of sudden cardiac arrest.
My husband's cardiologist is an In-Network provider, as well as the hospital he uses. The ZOLL Life Vest is the ONLY device of its kind made in the entire world, so there are no other such devices to choose from, and this is a life-threatening condition without such a device. This device is also an FDA Class III approved device, so it is no way considered an experimental device, and MOST insurance companies pay for the use of this device as an In-Network device, since there are no others made, EXCEPT CIGNA!
At no time did Cigna advise either my husband or his cardiologist that they considered this device as an Out of Network device, and until ZOLL themselves sent us a letter alerting us to this, and informing us that they were appealing this decision, we had no clue.
I made a complaint on the Consumer Affairs complaint forum, and lo and behold I get contacted through them the next day from someone at Cigna who said her name was **, and that she would like to help us with this matter. To make a long story short, she was a troll for the company whose job is to go through these boards and act like they are so concerned and want to help you. Well I bit, and sent her the information she said she needed, and she sent me back an email stating she got the info and was already at work researching the problem.
Three weeks later, after hearing nothing back, we receive the final bill for what we owe to ZOLL, with the Out of Network charges, meaning they turned down Zoll's appeal, and again no one told us. I emailed ** again, and this time I am told that she has no access to my husband's records, while remember that she told me she was researching our case and had all of the info, and that she had kicked it up to another department and had heard nothing back. So surprise, she had just put in another request on the day I just happened to get the bill and emailed her asking her what was going on.
My husband had reached his out of pocket cap for the year BEFORE the ZOLL bill went to Cigna, so we believe that this is an arbitrary decision on their part to charge it as an Out of Network claim, so they won't have to foot the bill for the entire claim, since my husband always uses In-Network providers and services, and has not reached the cap for his out of pocket expenses this year. I fired back an angry email to this **, which probably is not even her real name, and told her that this was a scam by her company, and that she had openly lied to me from day one, in order to stall, hoping that our time for an appeal would be up.
I filed a complaint with the Missouri Dept. of Insurance, as well as our own appeal to the APWU, which is the union for the USPS that my husband works for, because I am done dealing with this unscrupulous company. They are now going to have to explain to the state where they get off claiming this ZOLL Life Vest is an Out of Network claim, when it is the only device of its kind made in the world, and FDA approved for my husband's condition.
In short (full details are below) Cigna debited our HSA account to pay claims in the total amount of $1566 in mid-February and March 1st of this year. They did not, however, pay those claims, and have admitted to this fact. It is now May 17th. The money has been gone from our HSA account for 2.5-3 months. Instead of simply crediting us the $1566 that they took so that we can pay our outstanding medical bills, they are 'investigating' what they did with the funds. They will give me no date by which our funds will be returned.
The nitty gritty details: My husband's employer began using Cigna as a health insurance provider in 2011. We also have an HSA for the first time this year. In mid-February I had 2 claims, one on 2-15, the other on 2-17. Our deductible had not yet been met so both of the claims were sent to our HSA account for automatic payment. At total of $1,566.07 was deducted from our HSA account for payment to the providers.
In early March I was told by one provider that they hadn't received payment and were trying to work with Cigna in order to verify an EFT payment. In late April I received a bill from the other provider showing no payment had been received by them either. I called Cigna on 4-27 and was told by ** that they were working with the first provider (I'll call them Provider A) to track down the payment. Provider A, I was told, was being connected with a Cigna online business site that would allow the provider to track down all necessary information themselves.
Re the payment to provider B, I was told that an EFT payment had been made and was transferred to Chase (who runs the HSA) for further information. Chase informed me that everything ** had just told me was incorrect and that once Cigna debits my HSA account Chase can no longer see what happened to the funds.
So I called Cigna back and talked to **. She supposedly put in a request to get information as to how payment was made to Vendor B. She said that she hoped to get a response that day, or the next day at the latest, and would call me the following day with news. ** did not call me back soon the afternoon of 4-28. I called Cigna and this time spoke with **. She could see ** inquiry but said it looked as if it went to the wrong department. She said that she would put in a new request for tracking and would call me back on Sunday or Monday. She did not call me back.
I called Cigna again on 5-1 and spoke with ** who sent me to ** who, before I could stop her, sent me to Chase where I was told the same thing I was told before--Chase can't help me once Cigna debits my account. SO, I called back to Cigna again and spoke with **. She said that she could not see a payment being made in her system and that 'we are waiting to hear from that department'. I was supremely frustrated at this point and asked for a supervisor.
I was given to a supervisor named **. He said that he would find out if funds were paid to vendor B. If not, the funds that were taken from my account would be credited. If a payment had been made he would get me the check clearing info. I thought finally, I'm getting somewhere. But I was wrong. When I spoke with ** again on 5-4 he said that he could not find any record of payment having been made to Vendor B. He said that he would update the service request so that the money would be credited back to my HSA. He said that he would have verification within 24-48 hours and would call me back by that Friday, May 6th.
** didn't call me on Friday the 6th or Monday the 9th. I left him a voice mail on the 10th and on the 11th. Late in the afternoon of the 11th I got a call from ** (apparently calling instead of **). She told me that the payment matter was still under investigation. Cigna did take the money from my HSA and did not pay the provider, but that Cigna couldn't figure out where the money went. 'When the mystery is solved we will credit your account.'
At this point I was fuming. I explained that I didn't care what Cigna had done with the money or that they needed to figure out the glitch in their system. They admitted to having withdrawn money from my account and having not paid the vendor. There is no reason for further delay, I said, pay me back! She was so sorry, she said, but they were 'working' on it and she couldn't give me a date by which I would be credited.
On 5-16 I touched base with Vendor A to see if their payment issue had been solved. Big surprise, it had not. they had gotten online with Cigna's Business Services site but all the information that they could see was 'payment was made on X date'. No payment details or an audit to show which account the payment went into. As the provider said, "Cigna has been less than helpful."
I tried to reach ** again and could not--only voice mail. So I called the main number and asked to speak to another supervisor. I was transferred to **. She listened to my story with a mixture of horror and disbelief. She kept saying, "that just doesn't sound right that we would have taken money out of your account, not paid the vendor and drug our feet in returning your money." She apologized for Cigna's behaviour and said that she would do some research, get things straightened out and call me the next morning.
5-17: ** didn't call me this morning. I called her and she returned my call. She said that she is working with the client service partner (my husband's employer?) and her financial services department. It is confirmed that no check went out to Vendor B yet, she cannot tell me when I will have my money back. I explained to her that, in my eyes, Cigna's actions translate to theft and said that if any banking institution took $1566.09 from my checking account and refused to return it I would have solid grounds for legal action--same here--and I'm considering it.
She said that she was working really hard to get this resolved...blah, blah, blah. I explained that I had gotten that same story from every person I have talked to over the previous 3 weeks and that as 'hard as everyone is working on it' nothing is being done. She said that she 'escalated' the matter to a higher level. I asked if she was the first person to 'escalate' the situation and she said yes.
If this is true, it's a clear sign of how terrible Cigna's customer service is. This should have been elevated to a high priority situation on 4-27 and should have been resolved within a couple of days. Instead, the issue was passed around and ignored. I'm not hopeful that dealing with ** will be any different. I told her that I read Cigna's Ethics Policy online and got a huge laugh about their dedication to 'fair treatment of customers' HA! I have never been treated so poorly by any company in my life. Frankly, never imagined that treatment like this was possible.
NOTE: I asked what was happening with the payment to Vendor A. She said the investigation is currently on hold until the matter with Vendor B is solved... assuming Vendor B issue is solved they will use the same template to solve problem with Vendor A. Again, ridiculous. As if everything at Cigna were being done by hand with pen and paper in a back room. If they can't work on issues simultaneously they are operating in the dark ages.
IMO, they are simply not in a hurry to refund my money because they don't have to be. And that's what makes me the most angry. We are financially well off, but I know that this kind of gross incompetence could wreck some families with big medical bills and shaky credit. Absolutely, totally and completely disgusted with Cigna.
The consequences of this clustered mess is that we have medical bills that are due, and in some instances past due that we will either need to pay for out of pocket (and therefore lose the advantage of paying with pre-tax dollars with funds from our HSA) or risk having damage done to our credit... all because Cigna has taken our money and refused to return it. If anyone out there in HR is considering using Cigna, I can say loudly and clearly RUN THE OTHER WAY if you value your employees, their time and their sanity.
This could be a complaint, but I would rather it be more informative. When I returned home on September 29, I had a couple of checks from Cigna for health care that I had paid for in Singapore. Since I have an electronic funds transfer set up, where all my claim payments go into my checking account at home, I called to see if I should cash these checks. I might add that they had previously issued a couple of checks that should have gone direct deposit, canceled them and then reissued the money directly into my account.
One of the checks I recognized as being deposited into my account electronically, the other I did not, so I asked the CSA if her records indicated that this check had been cancelled or was it in the process of being cancelled. That way, I could shred it or deposit it, whatever the case.
The CSA was a big help in looking it up for me and stated that the check had not been cancelled and I was free to deposit it. She also assured me that it would not bounce when I questioned her about a possible cancellation. So, that day, September 30, I merrily drove to my credit union and deposited the check. Much to my dismay, yesterday, October 7, I noticed the check had been returned and I was charged an $8 service fee (!). Yep. When I called Cigna regarding this returned check and the fact that I still did not have the funds electronically, they said that they were being deposited today (October 8 - Yes, they are there now.)
I guess my point is you just can't believe everything they tell you when you call. The check was dated 9-6-09 and really should have been cancelled long before it was and the funds deposited into my account. It ended up costing me $8 for something beyond my control, and I can see how the amount deposited could have screwed up someone's account if they were cutting it closer than I do ($8 plus $230). Next time I will call--wait a week--then call again. You can never be too careful with some of these companies.
I asked them how this happened and they said it was a lag in the time it was cancelled and when they entered it into their system. I wonder why they don't enter it into the system immediately so their CSA's can give the correct information. I definitely don't blame the CSA.
CALIFORNIA -- I am retired, but my wife still works for the University of California, for health benefits. It's a good thing I'm retired, because since we switched from Blue Cross PPO to Cigna Open Access at the beginning of the year, keeping on top of them has become a full-time job.
We made the switch because, on its face, Cigna was a better deal than Blue Cross. The premiums were more than $100/month less and the maximum out-of-pocket expense was half of Blue Cross's. In addition, prescription drugs counted against the deductible, and co-insurance payments and once the deductible was met and the maximum co-insurance limit reached, Cigna paid for them 100 percent. Plus, the university sets aside $1,500/year, per household for medical expenses. You have to exhaust that amount before your deductible kicks in. If you don't spend it all, the remainder rolls over to the next year.
The final deciding factor for us was that Cigna seemed to cover all the doctors we were already seeing, including specialists I'd already been seeing at Stanford. And if necessary, we could have access to other specialists at UC San Francisco, another top teaching hospital in our region. For the most part, this plan has delivered as promised, but only with a lot of oversight on my part.
I have had a lot of experience with Cigna in the first year because, scarily a week into '08, I fell on ice and severely fractured my hip. This led to surgery, two weeks post-op hospitalization, one week of in-patient rehab, seven weeks of home confinement and then follow-up physical therapy (still continuing). The biggest problem with Cigna throughout this period has been numerous disputes over whether providers are "in-network".
All of the providers I've been seeing locally work for a single medical group which is under contract with Cigna. Yet Cigna initially ruled several of them as being out of network and paid accordingly (paying at 60 percent instead of 80 percent, and not counting the co-insurance toward our in-network, out-of-pocket cap). In one case, the doctor was considered out of network because Cigna had his physical address instead of his actual billing address (the medical groups).
In another case, they simply didn't have the doctor's name in their database. I was unable to straighten this out over the phone with Cigna's representatives and finally had to take Cigna's EOBs into the medical group's billing office, where I sat down with a real person who was ultimately able to resolve the issue. In a third case, Cigna said the physical therapist I was seeing was not in-network, even though she was employed at a facility operated by the same medical group. Once again, I had to personally go to the medical group's office to get this problem resolved. Once it was straightened out, however, it still wasn't fixed!
Despite the fact that Cigna paid three subsequent physical therapy bills correctly as in-network claims(and at 100 percent, our out-of-pocket cap having long since been met), they are at this writing still refusing to pay in full the first two -- resubmitted -- physical therapy bills, saying they'd already been paid. Well, yes, Cigna did pay them, but incorrectly, treating them as being out of network.
Yet in denying the resubmitted claims, they now showed the physical therapist provider as being in-network. It's enough to make one's head spin. I didn't even bother to call Cigna about this, knowing it would be a waste of time. I went back to the medical group billing office, handed them the EOBs and said, "They're at it again. Please take care of this."
Another issue I had with Cigna during this time was related to ambulance services. They don't seem to consider any ambulance companies, public or private, to be in their network. So they always treat the initial claims as out of network. I had to call them on each one, and I had several, to point out that these were emergency services; it wasn't like I could choose an ambulance company when I was lying in the street, etc., etc. They finally did pay the bills appropriately.
My bottom line conclusion: Cigna claims processing is incredibly sloppy and I think it's willful on their part. I believe they're betting that most subscribers will be too busy to pay close attention to their EOBs and will just pay whatever Cigna says they owe. That way Cigna gets out of paying what it owes, both to subscribers and providers. If you can make this plan work for you, it's good, but that will require an inordinate amount of work on your part. Subscriber beware!
ALBANY, NEW YORK -- I pay a lot of money into my policy with Cigna. The point of insurance companies is that they negotiate rates. Co-pays are to a) help cover expenses; b) discourage over-usage of doctors. I have never gone for any doctor visit that I didn't then get a bill for something from Cigna. Lab fees, or we negotiated and paid this amount and this is what you owe? What? No, I paid 3,000.00 for my insurance last year. +25.00/30.00 co-pays, and you want to come back and charge me more. How do they get away with it? Where is my voice? How much did their CEO, CFO, VP's get paid? It's crazy and I'm mad as hell!!!
DECATUR, TEXAS -- Been paying into Cigna $600 a month for 12 years without fail and now my wife needs a spinal fusion for bone on bone in her lower back and they refused the surgery saying a spinal fusion is experimental. They have been doing spinal fusions since the 1960's and have done millions of them... physical therapy failed and there is no other course of treatment that will work except surgery. Cigna had no other recommendations for treatment except that they wouldn't pay for surgery and she would just have to stay on pain meds forever. The surgeon has written multiple appeals to Cigna on her behalf with no success. Anyone have any other ideas???
After cancer surgery I contacted Cigna to get pre-approved for purchasing a specific L7900 Durable Medical device. I was told it was approved and I should find an in-network provider by calling a long list of names. After much effort and research I found an in-network company that provided the device. Based on Cigna stating they covered the device I then purchased it. But now Cigna denies the claim and states the L7900 Durable Medical device is not covered by my expensive PPO health insurance. I appealed the denial and they still denied the claim. I did everything I was supposed to do by getting pre-approved yet they still denied it.
Cigna never called back when they said they would and dragged this process out for 4 months. I could attempt a second appeal but I can already tell Cigna is so screwed up and fraudulent that the appeal would be denied. Kaiser was so much better to deal with and I will be going back to them during my company's annual health choice. I am stuck paying for this device even though I would have purchased another device at a lower cost if I knew it was not covered. I don't have the time to get a lawyer and document everything that has happened, but from what I'm reading about Cigna someone should file a class action lawsuit about fraudulently misleading customers.
The company is incompetent and has fraudulently misled me into making the wrong decision. Worse, they do not acknowledge their mistake and try to repair the damage done. This is the first time I've ever been so disgusted with a company that I found it necessary to file a negative report and I've been around 50 years. It is unfair to unsuspecting innocent people that unwittingly may get insurance through Cigna. DO NOT GET INSURANCE THROUGH CIGNA!!! You will regret it!!! DO NOT INVEST IN CIGNA STOCK. Eventually Cigna's incompetence and fraud will be well known and the company will face its demise.
Never in my life have I dealt with such a devious company. I would rather have a root canal. You fax a medical claim--you get a reply a month later in the mail that says they could not read it--buy a fax machine that will print clearly!
You mail a claim in yourself--they lose it. You need approval for a proceduregood luck--it took me a month of calling to get them on the same page with my company medical benefits and say yes the procedure was most likely covered and they would contact me later to let me know officially (NOT A WORD AS YET). These guys are outright crooks.
MADISON, WISCONSIN -- My boyfriend cut himself and called Cigna before he went to urgent care to get stitches. They told him exactly where to go and told him it was in-network. Then a week later gets a bill for the entire amount stating he went to an out of network provider. He called for an explanation and was told several different vague and misleading things. First he was told "you went to an out of network provider". When he informed them that this was the provider THEY told him to go to their response is "we have the power to decide what is in or out of network as we please".
Then he was told that urgent care is not covered even though all of his documents state they cover urgent care 100%. This company is SCAMMING people. From reports I have read this company denies over 90% of claims which anyone with common sense knows is not right.
GAINESVILLE, GEORGIA -- Be very careful with Cigna Health Insurance. They pay for medical services and two years after the billing they ask money returned to the hospital, and the hospital bill reaches the consumer asking for payment because the insurance has asked Cigna money back. The person tries to fix the problem with the insurance and they laugh at you and end the person is paying. They are real thieves.