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CIGNA Corporation Health Insurance

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Watch Cigna Like A Hawk!
Posted by Wary Consumer on 08/08/2008
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, scarely 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 group's). In another case, they simple 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!

     
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Posted by sallyct on 2008-08-08:
This is not Cigna, it is the way your medical group is billing. If they are not properly filling out the hcfa form, and putting the individual clinician in, instead of the group, your claim will only be paid in network if the clinician is also individually in their network. Sorry, but your beef is with the wrong company. That is why they are the ones who are able to "fix" your problem.
Posted by Wary Consumer on 2008-08-09:
The entire medical group is contracted with Cigna. It bills Cigna under its tax ID number. They use the same tax ID number regardless of who the individual provider is. I actually got into a heated argument with a Cigna representative who insisted that the medical group was contracted with Cigna at all. So I question whether this is a billing issue. Moreover, I am struck by the fact that even after Cigna acknowledged that the physical therapy provider who works for this group was in network, they refused to pay in full an earlier claim for the same provider that they had incorrectly processed as out of network. On the EOB, Cigna's explanation for the denial was that it was a duplicate billing for a claim had already been paid. It was not a duplicate billing. It was an attempt by the medical group to get in-network reimbursement for a claim that had been treated as out of network, and this after Cigna had already begun paying subsequent claims for this same provider as in network. Sloppy, sloppy, sloppy!
Posted by joshvhawaii on 2009-12-19:
All emergency services are paid at the in-network benefit level
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Denial of coverage
Posted by SgtMaj on 12/25/2007
OAK RIDGE, TENNESSEE -- I just read an article in the LA Times in which Cigna denied a liver transplant to a teenage girl who ultimately died because of it. In the article Cigna boasts of 90% approval for organ transplants. So it's supposed to be OK to kill 1 in 10 people?

All I can say is that they had better pray I don't get selected as a juror in the upcoming lawsuit, and I'll be writing a letter of petition to my company to switch providers.
     
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Posted by GothicSmurf on 2007-12-25:
I know I'm going to be labeled as cold for this, but I do have to speak my mind. While my heart goes out to this family, it seems you didn't read the whole article:

The reason this transplant was denied (at first) was because the insurance company didn't think she was healthy enough to make it through surgery or benefit from it in any way. They DID reverse their decision and the girl died a few hours after the decision... The day after she had a marrow transplant. Which kind of shows that she wasn't strong/healthy enough to have any more surguries.

Even if the surgery was approved from the start, she'd have to go on a waiting list for the kidney, it's HIGHLY unlikely she would have had one that day.

I don't agree with the decision of the insurance company to deny it and my heart goes out to the family, but it was NOT the fault of the insurance company.

Because I know that my view on this is NOT what people want to hear, I will NOT respond on this topic anymore, nor will I reply to PM's about it- Just as an FYI.
Posted by *Brenda* on 2007-12-25:
Gothic, I agree with you.
Posted by Anonymous on 2007-12-25:
Gothic, I also agree with you.
Posted by jktshff1 on 2007-12-26:
Gothic, well put.
Posted by yoke on 2007-12-26:
Have to agree with Gothic.
Posted by spiderman2 on 2007-12-26:
I agree with the above and there is more to this story than an insurance company denying coverage and killng this girl. If she was healthy enough for the transplant, why didn't the hospital and doctors just do it and worry about getting paid later. If it were my kid and money was all that stood in the way, I would sell all my worldly possessions and figure it out later.
Posted by jenjenn on 2007-12-26:
You go Gothic!!
Posted by Anonymous on 2007-12-26:
I fall in line with everyone else, Gothic is 100% correct.
Posted by Ponie on 2007-12-26:
Gothic, don't be concerned about PM's to your response. The majority of us agree with your statement so if you get any, they'll be comments of support.
Posted by Anonymous on 2007-12-26:
It shouldn't be up to an insurance company to approve or disapprove a surgery. What is this country coming too when we let corporate America and not our own doctors make life or death medical decisions. Are you kidding me? Do you really want some insurance lackey at a desk deciding whether you're healthy enough to make it through surgery or not? What a conflict of interest when the companies responsible for paying for the services are the sames ones deciding if the services are necessary or if the patient is healthy enough. Disgusting.
Posted by Anonymous on 2007-12-26:
Stew, as always I side with you, friend. Yolk, you bring up interesting insights as well.
Posted by Anonymous on 2007-12-26:
Gothic: (BA)
Stewart, how goes it? How was the Christmas "hoedown" out there in Lawton?
Posted by moneybags on 2007-12-26:
You go, Stew.
Posted by Anonymous on 2008-01-04:
I know that it seems like a play on words, but CIGNA did not deny the transplant. They have no legal right to deny the actual surgery. What they did originally was deny payment for the surgery. Believe me, I am in no way defending the decision that CIGNA had made. If it was my child if they needed the surgery and was strong enough to have a good chance of surving, I would have done whatever it took to get her the transplant. Even if it meant selling the house and the only thing I could afford to eat for the rest of my life is the gross 25 cent box of mac & cheese.
Posted by Anonymous on 2008-01-04:
Spiderman - in my own experience, the hospital won't perform the surgery unless they receive the approval from the insurance company. I am currently trying to get a kidney transplant, and the cost of the surgery is more than my maximum annual insurance allowance.
Posted by Anonymous on 2008-01-04:
Dang, Cherpep...that doesnt seem fair. Would you be able to get your insurance company to give the hospital an approval with a stipulation on the maximum that they will pay? Then you could work out the difference with the hospital? You are between a rock and a hard place. It just doesn't seem right. :(
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CIGNA--A Root Canal is easier than getting approvals or claims processed
Posted by Fatcatzz on 01/15/2010
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 procedure---good 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 out right crooks.
     
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Posted by Anonymous on 2010-01-15:
What type of procedure were you having done? The insurance company may not always approve something if they don't feel it is medically necessary.
Posted by goduke on 2010-01-15:
You really need to be complaining to your company's benefits administrator. That's the kind of thing that tends to get a response. Benefit Admin's hate being bugged about the insurance company not doing it's job (because they see how much they pay them), and usually bark at them pretty hard.
Posted by BEJ on 2010-01-15:
Look at your benefits book. If it is a covered procedure--it should be paid for. That being said, it does not mean that approval/prior authorization is not needed. Having said that, if it is not an urgent procedure it may take more time for approval--also if it is not medically necessary you may not get approval. There should be a grievance procedure that you can go through with your insurance to get it looked at a second time.
Posted by Anonymous on 2010-01-15:
BA BEJ. Having medical insurance doesn't entitle automatic approval for certain types of procedures, especially for radiology tests (CT's, MRI's). If a procedure gets denied, you can file a grievance, like BEJ stated. Sometimes procedures get denied due to lack of medical information recieved from the dr or the patient
Posted by Anonymous on 2010-01-15:
goduke is correct. Be sure to let your company's benefits administrator know what's going on. They'll get to the bottom of it.
Posted by azpaulh on 2010-01-16:
My experience with Cigna is similar. Their doctors recommended that I have a colonoscopy last June and when I tried making an appointment at the front desk was told that I cannot make an appointment directly as it had to be submitted and they would advise me of a date at a later time. Six months later I am still waiting. I should add that I am a Medicare patient and had used Cigna's own facility and doctors. It's probably a great plan so long as one does not neet medical attention. I am in the process of switching to Health Net and will see if they will approve the procedure any quicker. This was not the only issue I have had with Cigna. They are taking money from the government under false pretenses.
Posted by BEJ on 2010-01-17:
Littleyaya: I never said that medical insurance entitles automatic approval. I said that if a procedure is not medically necessary approval may not be obtained. I was trying to give the op several reasons why they have not gotten approval and suggested that they go back to the insurance company for a second look.
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Cigna Denies Over 90% Of Claims
Posted by Triam on 01/20/2009
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.

     
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Posted by madconsumer on 2009-01-20:
insurance coverages have become insane. i recall a story about a lady who birthed her baby at the wrong hospital, and her coverage was denied! as if she had a choice.

in todays world, many people are having this very same issue with their coverage. best i can suggest, save the bills, and claim them on 2009 taxes.

great review.

very helpful.
Posted by Disaster Worker on 2009-01-20:
I suppose their alternative was for him to suture himself? Or possibly Madconsumer's story, the woman deliver her baby herself?

It really is quite crazy what insurance companies want to get out of paying. As a healthcare provider, I know of too many nightmares regarding insurance! I say to fight the claim and stick with it until they pay.

Unfortunately, you must accumulate a tremendous amount of medical bills before they are deductible from your taxes. Most people would never qualify for the deduction.
Posted by Mrs. V on 2009-01-20:
For medical bills:

If you itemize your deductions, these expenses are deductible only when paid by you, and the unreimbursed expenses exceed 7.5% of your adjusted gross income. These expenses include the premiums for insurance that covers the expenses of medical and dental care, and the amounts you pay for transportation for these purposes.

It's not to hard to reach for a family or for someone on a lot of medications to reach 7.5%.



Posted by JennieGirl on 2009-11-06:
I had nearly the exact same situation happen to me last year. I fell through our window while trying to clean it (don't ask!) and my wrist was cut open. I was bleeding out everywhere and was very worried that I had cut an important vein or something. Long story short, we drove to the nearest hospital and had me stitched up and put on antibiotics. And of course, two weeks later I receieved a bill for the full amount (over $2,000 for 10 stitches and 10 pills) since we didn't call Cigna first to see if the doctors in the hospital were in the network. I was gushing blood on the floor at 1:00 am and we were supposed to call the insurance company?!?Sorry, but I thought that insurance was FOR emergencies! When we had Blue Cross everything was covered, but this? These scubbags will take your money and give nothing in return. It's expensive, but I'm going back to Blue Cross. At least they won't leave me to bleed to death.
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Don't Believe Everything You Are Told
Posted by on 10/08/2009
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.
     
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Be Very Careful With Cigna Health Insurance
Posted by Lapitonisa28 on 11/15/2013
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.
     
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Posted by Soaring Consumer on 2013-11-20:
File a complaint with your state's insurance commissioner.
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They Are Scam Artists
Posted by Julie481 on 10/17/2013
, 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 it's 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 a 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 Ann, 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 Ann again, and this time I am told that she has no access to my husbands 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 Ann, 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 it's kind made in the world, and FDA approved for my husband's condition.
     
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Posted by cmthru on 2013-10-17:
I have a friend who used to be with CIGNA. They paid for little including nothing for a flu shot.
Posted by LC on 2014-03-06:
What ever came of this? Did your insurance company end up paying?
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Thieves
Posted by Pahaggerty on 01/16/2012
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!!!!

     
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Posted by tnchuck100 on 2012-01-16:
All the heath insurance companies are like this. I have been convinced for years that our co-pays and deductibles actually pay for the medical care. All the rest is gravy money for the higher up, non-medical administrative dead wood in the system.

If 100% of Americans stopped paying premiums to health insurance companies then we would be charged something reasonable and affordable for our medical needs. There would be no administrative dead wood draining the money.
Posted by Anonymous on 2012-01-16:
Insurance companies negotiate rates with providers (doctor's and facilities), not patients. Your copays only cover the office visit. If they do any type of test or procedure in the office, then (depending on your plan) it will go to a deductible or you will be repsonsible for a percentage. All insurances do this.
Posted by clutzycook on 2012-01-16:
Last year we had BCBS's PPO. A visit to the PCP for a sick visit cost us $76. This year we have the HMO. Our co-pay is $50. So BCBS is paying $26? WTF?!
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Cigna takes your money every month and then refuses all claims to get richer !!!!
Posted by Bigjessewhitehead54 on 11/10/2011
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 ????
     
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Posted by Alain on 2011-11-11:
I happen to have some disks fused in my lower back and I can certainly tell you that there is nothing experimental about it. Additionally, I had a couple of rods put in my back & some screws, as well. My insurance (I'm in Pennsylvania-I don't know if that makes a difference) covered the procedure. I'm able to walk upright and have been since my surgery a few years back, so I consider the surgery quite successful. You may want to take a look at the Texas Department of Insurance website, http://www.tdi.texas.gov and, if necessary, think about talking to an attorney. This is the second CIGNA complaint I've seen today. I'm not very impressed with the way they do business at this point. Thank you for your helpful review.
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Posted by Wwwdrew91 on 09/20/2011
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 the 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.
     
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