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Change In Policy And Notification
Posted by ToxDoc on 02/24/2009
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 mangement 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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Posted by 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!
Posted by 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.
Posted by Principissa on 2009-02-25:
Our insurance company puts any notifications in with the bill. No excuse not to notice.
Posted by ToxDoc on 2009-02-25:
we read our mail even if it is so called junk mail for exactly teh 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 dont then I will know that I have a bigger problem than I first thought. Thanks again for the advice - althought some appeared to be rather remonstrative. Regardless, I dont intend to go down without a fight as Proverbial "they" say. I would appreciate any constructive ciriticism or advice that can be tendered.
Posted by 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)
Posted by 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 thought 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.
Posted by 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.
Posted by 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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Cigna Tel-drug Idiocy Accidental Or On Purpose
Posted by Smry on 09/29/2008
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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Cigna Fails In Its Promise to provide financial security in the event you become disabled.
Posted by Libertythink on 02/27/2008
I paid group disability premiums for 25 years. I was disabled from working in Jan 2006. Only after writing government officials & filing an insurance dept complaint did Cigna agree to pay. Then after approximately a year of payment Cigna suddenly (without informing me in advance)writes me I am no longer disabled and can return to my regular occupation. This letter came AFTER the check did not show. My physicians support that nothing has changed and I continue to be disabled. This is what Cigna did:

1) They sent my file to two of their doctors for review (of course they wrote "deny" as Cigna pays them to do.

2) They sent the file to their in-house Nurse who wrote "deny" as Cigna pays her to do

3) Put surveillance on me two time which reflected I was not active and info actually supported my case. Sent me to a Functional Capacity Exam which supported I was disabled

4) FINALLY they found a doctor to perform an IME who agreed I was not disabled and was paid $2,000 for a 30 minute exam.

I am appealing the decision but you need to know that Cigna will do everything it can to disclaim benefits you may have paid throughout your career. The federal government really needs to come down on disability companies and enforce major changes to protect the consumer.
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Posted by jenjenn on 2008-02-28:
Is this a short term disability plan or long term? If it's a short term, they year is probably the max benefit.
Posted by mzmickey on 2008-03-06:
Cigna is impossible to deal with. They just don't care. Thanks for giving me a couple more routes to try.
Posted by tumblewic on 2008-03-14:
I am also having problems with Cigna, no one will return calls, emails, or anything. They keep moving my decision date to decide whether I am qualified for long term or not, but until they decide, there is NO income coming in!!
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Refusal of Service
Posted by Samulski on 01/20/2002
HOUSTON, TEXAS -- I attempted to see a hand specialist but was told by my primary care physician that I needed to confirm the referral directly with your office. At approximately 2:00 p.m.,one of your representatives informed me that I could see the doctor so I waited in his office for 90 minutes. When I called back to find out what happened to my referral, I was informed that I could not see that doctor.

To help keep me as a potential future customer, I would like the following:

At that time, I asked to see the doctor in question at your company's expense since I had sat in his office all day before anyone figured out why my referral could not be processed. Your representatives were not willing to consider this option, even though it was almost 5:00 p.m. and I had not seen a specialist yet.

Furthermore, given that it was late Friday afternoon before this issue was cleared up, I have been unable to get a referral -- yet alone an appointment -- to see another physician.

Thus, an error on the part of one of your employees is preventing me from recieving timely treatment.

At the very least I would like a response from your company regarding this incident. Thank you for your time.
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Warning If You Have A Choice; Don’t Use Cigna For Your Fsa!!!
Posted by Lbgunvalson on 04/18/2014
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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Posted by Luann2kids on 12/05/2013
MOOSIC, PENNSYLVANIA -- I left Cigna on 9/7/13 (gave 2 week notice) they sent my last check to my. However on Monday 12/2/13 I received a letter stating they over paid my by almost 800.00 in PTO days....they want payment in full by 12/12/13. I am so furious that it took them 3 months to figure out that they overpaid me which I request proof of my PTO days that I took and what I was allowed and it will take 7-10 business days. How dare they do this to me. Is there anything I can do about this if I do owe them the money?
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Horrible Company
Posted by JoelHughes30 on 11/06/2013
BLOOMFIELD, CONNECTICUT -- For the last 3 months I have been battling this horrible company to approve my short term disability claim. I was taken out of work by my Dr. due to a back injury that is chronic in nature. I also am diagnosed with depression which can be very severe in episodes and very debilitating. On 8/21/13 I took this leave and since returned to work on 10/21 because my claims were denied. I had no other choice...go back to work or lose my home despite the circumstances. I was shuffled from person to person at Cigna and all they basically did was bury me in paperwork and never once did they actually speak to my Dr. I appealed the decision only to find out today it had been denied as well. The company's motto is: "To help the people we serve improve their health, well-being and security." This couldn't be any further from the truth. I would advise anyone looking into this company for insurance to RUN away as fast as you can. Statistically speaking, Cigna denies 1/3 of their claims and seems to be more concerned about their bottom line than the individual. I filed a complaint with the Washington State Insurance Commissioner with the hopes of at least sending this organization a message. For as much as we all pay for insurance in this country it would be nice to know you can count on it when you need it. I'm just utterly disgusted by the way Cigna has treated me and others.

I hope this company gets a big wake up call and finally realizes that it can't go on treating people like this.
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Posted by Mandm048 on 09/12/2013
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 lied about what was included in my policy
Posted by on 08/10/2012
LOS ANGELES, CALIFORNIA -- I have now been a member of Cigna for a few months and have found out that the sales representative lied to me about 2 different items. I signed up for a health and dental plan. The sales representative told me that I would pay 15$ for generic perscriptions and 30$ for name brand. The reality is that generics were in fact low priced but the name brands would cost me full price and Cigna won't cover any of it. Thats a pretty big lie in my book.

Then I found out yesterday that having dental insurance doesn't mean squat. I had a filling pop out and could not eat or drink anything because of the pain. I made an emergency appointment with my dentist only to find out that Cigna doesn't cover emergency's until after 6 months or 12 months. In my mind I have insurance exactly for the reason of emergency's. Again, this is where the sales representative lied to me. I fully understand not covering elective procedures but to not cover emergency procedures, that is absurd. This is a huge lie by the sales representative.

I then called customer service to try and deal with the dental situation and was given the run around and told that the only way I could attempt to get Cigna to cover the procedure was to write an appeal. So let me get this straight, your company lies to me, sells me a bag of goods, and then tells me its my problem and my responsibility to fix? Does this sound like a scam to anyone else? I will be cancelling my policy with Cigna and finding a company that is honest, knows what customer service actually is, and actually provides the services that you pay for.

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Posted by leet60 on 2012-08-11:
As for your dental insurance, the waiting period is fairly typical and it is likely they consider the issue to be a preexisting condition.

For your prescriptions, I cannot be sure about your area but the Walmart pharmacy in my area will fill generics for a payment of $4.00. It may be an option for you to try.
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Denied $10, 779.00 for covered services.
Posted by Houzeman on 08/08/2012
Letter From Service Provider
Letter From Service Provider
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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Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by olie on 2012-08-09:
Cowboy Fan, you explained this well.
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