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Denied medication for sinus infection needed from compounding pharmacy
Posted by Rob.pat.henry on 07/10/2012
MARIETTA, GEORGIA -- Cigna denied my sinus infection antibiotic treatment prescribed by my ENT, and this medication has been compounded and used by me for years prior to Cigna coverage.

I have increasing kidney failure probably from multiple antibiotics from constant sinus infections caused by Common Variable Immunodeficiency Disease. My kidneys and immunodeficiency will not get better but sometimes am prescribed nasal infusions to put most of the medicine where the problem is and help spare my kidneys.

This is an acute condition yet they denied it based on diagnosis and "safety". They are denying medication prescribed by my doctor because they think he practices unsafe medicine or does not know the best prescription for my particular problem?

     
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Posted by CIGNAQuestions on 2012-07-11:
Hello, I can look into your account to see what else can be done for you. If you would like my assistance, please email me at LetUsHelpU@cigna.com. Thank you.
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Conflict Of Interest Involving Labor Law Discrimination Retaliation
Posted by Bridgetwills99 on 06/06/2012
EAST SYRACUSE, NEW YORK -- I am a survivor of labor law discrimination retaliation & personal permanent injuries resulted from the retaliation including property damage, death threats & vicious acts of hate, resulted from my N Y State Workers Compensation Board Cases WCB69709892 OGC 08-230 traveling with WCB69711246.

Cigna was the administrator for my husbands employee elected benefits for medical for him & me, Cigna HMO breached the medical contract/denied medical & removed our PCP physician from the contract & added a physician they had the conflict of interest with to deny medical care. After I was assaulted in June 1999 Cigna contacted the PCP requesting the assault go under NY State Workers Comp. Case WCB69709892, the PCP was concerned & wrote it in my medical record.

Their Legal Dept in the State of Connecticut have the record on it.
     
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Posted by clutzycook on 2012-06-07:
So, what exactly happened and what does your WC claim have to do with Cigna, or what does Cigna have to do with your WC claim?
Posted by bridgetwills99 on 2012-06-07:
Hi clutzycoook: Cigna HMO was located in East Syracuse,NY ( I live in Liverpool,NY,I Used E,Syracuse because I thought it would post on that address)

Now to answer your question how NY State Workers Comp.Board is involved,Most of the info,I got thru the Medicare Investigation Project Investigations & NYS WCIA Susan Bently @ AG Office./Lawyers Ethics, GSA Waste & Abuse .I was declared disabled due to a head injury I sustained in June 1989 @ my long time employer;Nationwide Insurance Co.They fired me upon my return to work.They needed a Social Security Administration (SSA) Disability Decision( SSD) decision to keep paying me my Benefits. SSA Office Syracuse,NY. completed my paperwork for Nationwide Ins.Co.& denied me SSD. Nationwide Ins.then had the power to cancel all my Benefits based on: " SSA Denied me SSD." I was then ref.by Orthopedist surgeon to a program called; N Y State Education Dept. Vocational Education Services for People
with Disabilities (VESID) According to Susan Bentley,N Y State Workers Comp.Internal Advocate for NY State Attorney General's Office , It was a mystery that NY State VESID had me in the program thru BOCES when SSA denied me SSD claiming I was NOT disabled.Medicate Investigations Project Investigations also agreed. BOCES ( ONONDAGA COUNTY) PLACED ME IN EMPLOYMENT @ a Syracuse,NY Local Hospital as a Unit Receptionist working week ends only. BOCES (ONONDAGA COUNTY) Counselor wrote a letter to NYS VESID that my wages were way more than I was making, I wrote up a safety concern report for the Hospital involving I did not want to do patient care & patient transportation including taking off doctors orders.(long story) the hospital fired me resulted in NYS WCB69711246.
I then searched for work on my own to stay away from the State Agency's. Retaliation took over.
State University Of New York,(SUNY)Physical Medicine Rehabilitation were also involved because my PT/Spine rehab was thru them. NYS VESID got involved again & placed me at Health Services Assoc,(PHP working as a mail room clerk (full time as mim.wage) I was pushed head first in to a metal filing unit by a medicare coordinator of benefits when I was bent over filing I sustained a severe permanent injury on July 22,1997,ref; NYS WC Claim WCB69709892.I was AWARDED SSD AFTER THIS INJURY. lONG AFTER IT WAS BROUGHT TO MY ATTENTION THE MEDICARE COORDINATOR OF BENEFITS WAS A FORMER NATIONWIDE INSURANCE EMPLOYEE INVOLVED IN WCB69709892.
Cigna HMO were my husbands employee benefits Administerators for his elected employee medical benefits which were contracts for him and myself for medical. Cigna breached the contract,removed North Medical Family Practice (DR FIACCO PCP)& applied Family Practice Assoc Dr,Fazio to the contract. all medical was denied. At this point Fraud was spreading involving the labor law,Hippa violations
death threats related to labor law,property damage and ethnic acts of hate.According to Medicare Inv.Proj/MSPRC lisa LaChapelle,Supervisor for CIGNA in my case ( located in the State of New Hampshire for subrogation on what they paid out)
ref,it to Cigna Legal Dept.in Connecticut)
NY State Dept.of Health Office of Certificate & Surveillance (Albany NY) did an investigation on it also ref;( 98-11-30010) they denied Freedom of Information on it ( FOIL) Cigna then cancelled my husbands HMO & Aetna took over & REFUSED to insure me. AETNA lawyer in the state of Connecticut even denied to Medicare Investigator that they insured my Husband. Later an Aetna employee 'CONFIRMED TO INVESTIGATOR THEY INSURED MY HUSBAND & REFUSED TO INSURE ME BECAUSE NYS WCB ..
Posted by bridgetwills99 on 2012-07-15:
:
See my posting on (SYRACUSE.COM)on WOLFF GOODRICH & GOLDMAN ( lawyers in SYR,NY) the posting is related to the LABOR LAW DISCRIMINATION RETALIATION/NYS Workrs Comp. Cases when CIGNA HMO WAS INVOLVED (Judy Taber,was Cigna,Mgr,@ the time.Ron Harms was the CEO I believe @ that time combined with conflict of interest with NY State Dept.Of Health/NYS Education Dept. VESID INVOLVING NYS EDUCATION DEPT.VESID/ Onondaga County Cortland,Madison BOCES (OCMBOCES)in this case Onondaga County BOCES,Harriet Silverman (BOCES) WAS/IS SISTER IN LAW TO DR.RUSSELL SILVERMAN,HEART & LUNG SPECIALIST,EAST SYRACUSE,NY. IT IS HE WHO STOLE THE EMERGENCY RECORDS FROM ST.JOSE'S HOSPITAL EMERGENCY ROOM THAT WOLFF GOODRICH & GOLDMAN WERE INVOLVED IN WHEN THEY ISSUED THE SUBPOENA TO THE HOSPITAL.
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Complaint
Posted by Joeykelley on 05/10/2012
I have had back surgery and have been out of work for about 6 weeks. I have received one check for my short time disability so far. I have made several attempts and number of hours one the phone and still getting the runaround by Cigna. They take your money every check but don't pay out.
     
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Posted by Alain on 2012-05-12:
I'm going on the assumption you're in Alabama since that's what's on your review. Contact the Alabama Department of Insurance at (335) 269-3550 and/or file a complaint via http://www.aldoi.gov/Consumers/FileComplaint.aspx
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Was declined chest CT scan prescribed by family dr. by irrational reason
Posted by Simonshijr06 on 08/03/2011
L.A., CALIFORNIA -- I was still declined with imaging center and my family dr. presenting all supporting doc. Unfair. cause I would pay big portion, probably the whole amount to satisfy my deductible, Dummy dahhhh.
they gave several reasons, which showing none of reason holding water, " Multiple choices " - too many sayings.
1. no previous treatment for cough, pain in chest -
i said there was pain both my chest on and off more than 1 yr, which I don't like to take pain pill of much side effects.

2. x ray was clear, no need for ct scan.
ct scan and x ray are both diagnostic test, ct may see detail tissue for tumor. if x ray showed positive, I would be terminally ill to die. purpose of ct scan is to detect tumor early to prolong life. idiot!!

3. family dr. prescribed ct scan.
i don't think dr. would lie for me to risk his license - bread and butter.


     
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Posted by Anonymous on 2011-08-03:
Just because the dr ordered a ct doesn't mean your insurance company has to approve it. If they don't find it medically necessary, they won't approve the test
Posted by BEJ on 2011-08-03:
LS is right on the money. Just because a test/procedure/treatment is ordered by your physician does not mean it is automatically paid for even if your insurance is a PPO. There must be a medical necessity for the test. I think reasons 1 and 2 are reasonable responses.
Posted by Anonymous on 2011-08-03:
Great review, very informative, I would keep at the insurance company to payup. Don't let them off the hook with that rationalization that it wasn't a medical necessity. Goodluck!
Posted by madconsumer on 2011-08-03:
often times insurance companies fight payment to save money. AFR is spot on, keep at em until they succumb to pay.
Posted by Anonymous on 2011-08-03:
Radiation treatments, such as CT's, are often ordered un-neccesarily. Why should the insurance company pay for a test that isn't needed? The X-Ray report was clear enough. What was a CT going to show that the X-Ray didn't? Too much exposure to radiation is harmful anyways
Posted by Anonymous on 2011-08-03:
Insurance companies are greedy bottom line.
Posted by Anonymous on 2011-08-03:
Oops too late to edit. That should say 'radiation tests' not 'radiation treatments.' Big difference
Posted by Anonymous on 2011-08-03:
Very astute madconsumer!! Also these claim representatives are trained to keep the payment process going real slow. I hope the OP gives us a followup and maybe we'll have another review "resolved".
Posted by Anonymous on 2011-08-03:
No we're taught to know what should or shouldn't be paid, according to the plan benefits
Posted by Anonymous on 2011-08-03:
I would suggest perhaps in the future when is this is settled, to seek out another insurance company like empire etc. There's plenty of them out there that would welcome your business.
Posted by Anonymous on 2011-08-03:
I hate to say it (not because little said it, but because it is true) that some radiation tests are not a covered plan benefit on many insurances and those that cover it make you jump through so many hoops that its not even funny. I say keep fighting until you exhaust all resources. I have had to fight tooth and nail to get some of my cardiac test covered. Not sure what it was called but its the one that they inject you with radiation and then do the scan.
Posted by Anonymous on 2011-08-03:
Oh, and I'd have to agree with Wally. Insurance companies have shareholders to report to for earnings. Too bad they aren't all non-profit.
Posted by Vinnie11 on 2011-08-03:
I'm sorry, I don't understand this. If you have a high deductible and you have to pay for the service anyway because your deductible hasn't been met, what is the issue at hand?
Posted by CrazyRedHead on 2011-08-04:
My husband has BCBS through his employer and he pays a high premium so we don't have a copay when going to the dr, but if the deductible isn't met then we have to pay out of pocket for part of it until it has been met. I thought this was standard for all health insurance companies?
Posted by Skye on 2011-08-04:
Doesn't Cigna require prior authorization from them, before you have any medical procedures done?

What does your policy say about prior authorizations for CT scans?
Posted by Anonymous on 2011-08-04:
The company I work for requires a pre-auth for radiology or we will deny the claim. The ordering physician can send us medical records after we deny the claim. But it sill doesn't mean it will get paid.
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CIGNA Tel Drug Users Beware
Posted by Anti Cigna Tel Drug on 03/31/2011
Our family has been using CIGNA health insurance for the past 8 years and have nothing but compliments on their service, prompt payments, etc. However, their related company CIGNA Tel Drug is HORRIBLE. My twin boys were scheduled to have a specialty drug injected once a month during the first flu season of their lives. One night, after never receiving a bill, they called at 9:00 pm indicating that I needed to pay $997 over the phone to process the next months dosage that needed to ship next day. I went ahead and gave them credit card while I filed the secondary insurance to expediate the process. When my credit card statement came, they had charged me $1440 and had no explanation for the change in authorization amounts. In addition, I had manufacturer coupons up to $500 a month that I wished to use. The associated told me that I would need to speak to a supervisor to use, but I was transferred to no avail to the supervisor's voicemail. I have left 4 messages in the last three months for a supervisor or manager to return my call regarding the change in authorization amount and my coupon cards, but still have not heard back. Thus, we have continued to pay the copay without the reduction of $500 each month for twins....$5,000. Today was the newest issue. They did not ship our monthly drug that has to be administered within a five day window. This Company is a joke with horrible customer service. The only reason why they are still in business is because you have to use them through CIGNA in most cases or for a reduced rate. CIGNA has been great, they should lose this loser subsidiary and go with Walgreens!
     
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Child with epilepsy Cigna won't pay for medication
Posted by Eriknwill on 03/10/2011
I couldn't believe it when my niece called me today crying because CIGNA won't pay for her son's Epilepsy medication.

She can't afford the medication for her 11 year old son called Trilept. I can't believe a large company like CIGNA thinks it's o. k. for a child to have seizures while setting in class or in the middle of the night banging his head on the floor. Sine see has insurance she can't get any help paying for the medication because if you have insurance drug companies won't give him the Trilept or discount the price.

My niece is afraid to take him to see his gran-father who's dying from cancer because she doesn't want him to see Erik have a seizure.

I could understand if they denied an old person like myself that's already lived a long life but I don't understand how they could do this to a 11 year old that also has Asperger.
     
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Posted by leet60 on 2011-03-10:
I am not certain why your niece is being told this, I have Cigna and the medication you are referring to is known as "Trileptal", an anti-seizure medication. It is not only on the approved drug list for Cigna coverage it is listed as a preferred brand in suspension form and also available in tablet form.

If she is getting this information it is not covered from the pharmacist she may want to try another pharmacy.

Good luck.
Posted by Anonymous on 2011-03-10:
Trileptal is used to control partial onset seizures, so any headbanging is more likely to do with a characteristic of the mild autism. If not, the child should have a comprehensive med reevaluation, as headbanging during seizures is a sign of a different type of seizure that would best be managed with different medication.
Posted by Venice09 on 2011-03-10:
Is your insurance also refusing to pay for the generic version of Trileptal? You might want to ask about that.
Posted by jktshff1 on 2011-03-10:
I would check with the child's Dr. May be the diagnose that is causing the problem.
Good luck
Posted by Venice09 on 2011-03-10:
My son took Trileptal for off-label reasons, and when the generic became available, the insurance company refused to continue paying for the brand. Most generics are good enough, but in the case of Trileptal, the brand works better. Despite the prescription for Trileptal and the doctor's recommendation not to use generic, they flatly refused to pay for the brand.
Posted by spiderman2 on 2011-03-10:
I imagine that the reference to the child banging his head on the floor is a refernce to falling during a seizure and/or thrashing around during a seizure. I would take leet60s advice and check with another pharmacy and have your daughter call Cigna and found out exactly what is going on. I have a son with Asperger's Our insurance that we pay a small fortune every month for covers very little of his therapy costs. It is not personal, if we had a large company, it would all be covered, but because we are a small business we do not qualify for autism services coverage. I don't know what state you are in, but your daughter can check out what her state offers in the way or progams to help pay for her son's epilepsy and autism issues.
Posted by Anonymous on 2011-03-10:
spiderman, "falling" and "thrashing" (convulsive) seizures are atypical of partial onset seizures, they are characteristic of other type seizures which are controlled by varying degree by other seizure medications. It really sounds like the child suffers from more than one type of seizure, which is quite common, if headbanging is involved, , and needs to be managed by more than one medication, if not a different medication altogether. Also, Op she may qualify for state assistance also, being a special needs child, despite the fact she has insurance, in which case the state may cover it.
Posted by danny54 on 2011-03-10:
Would your niece's doctor be able to provide some samples of the medication until this situation is resolved?

Maybe I missed it, but has she called and talked to someone at CIGNA?
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Medical Claim denial
Posted by Rosieposie25 on 01/30/2011
DALLAS, TEXAS -- I was diagnosed last year with a hole in my heart. I have three doctors that have indicated that this procedure is medically necessary to my survival. My doctor has spoken to the medical director, wrote letters outlining why this procedure is medically necessary and sent all the required documentation to support that the procedure is medically needed. Every time I tried to get an update on the status on my claim I receive a different reason for its denial. One time it is there is not enough documentation to support that it is medically necessary. Next time I am told that this procedure is not fda approved and considered experimemtal. I found out a week ago that cigna approved the same procedure for another cigna patient.
     
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Posted by tnchuck100 on 2011-01-30:
They may continue denial until they see some legal heat headed their way. You can bet they are hoping you will just give up and go away. I would at least consult with an attorney.
Posted by Anonymous on 2011-01-30:
Just because a procedure is ordered by a doctor doesn't mean your insurance company will cover it. Have you looked through your benefits brochure to see if experimental procedures are covered?
Posted by Anonymous on 2011-01-31:
I have had some experiences with Cigna. Both when I worked at a medical office and also from my own personal experience. They deny things that should be covered all the time. You have to appeal and appeal. I truly believe it is a delaying tactic they use on everyone. Don't give up. If you can provide proof that they paid for the same procedure for someone else, provide that information to them. If that doesn't work, the next step is your insurance commissioner. I dealt with many insurance companies and found that Cigna was one of the worst for paying valid claims. They were also notorious for giving different info every single time you called.
Posted by leet60 on 2011-02-01:
Despite what many believe, claims department representatives at insurers are paid to find a reason to deny everything possible. They are not on your side. I agree with tnchuck100, you need to throw some legal heat their way.
Posted by rosieposie25 on 2011-03-17:
Thank you all for your advice. The stall tactics that Cigna is using is not going to work. They will be getting alot of heat coming there way. I am going for broke which means Cigna out of business.
Posted by rosieposie25 on 2011-03-17:
Let me know if any of you have figured out which tv stations,newspapers and or radio stations that are not bought off by cigna and are willing to expose them for the crooks they are please send me a message. Thanks
Posted by rosieposie25 on 2011-03-23:
I was turned down today and this was my second appeal. Please everyone continue fighting for what you believe in, Cigna thinks it is over but I will never stop fighting and neither will my husband so I hope they are ready to go out of business
Posted by Anonymous on 2011-03-23:
Good luck, Rosie.
Posted by rosieposie25 on 2011-03-25:
Thanks Nicole
Posted by rosieposie25 on 2011-04-02:
I just mailed in the final external review for Cigna. This review is done by people not associated at all with Cigna. My feeling is when someone has something that needs to be done or a treatment that is needed than the insurance company needs to just pay it. Especially since we are paying the high premiums, The outcome affects the patients and their families' lives not the insurance company. So the decision to have the procedure I need done should be between myself, my family and my doctor and no outsiders like Cigna,
Posted by rosieposie25 on 2011-12-25:
I never gave hope as I continued to fight for what I believed in. Now I had the procedure done and I am doing well.
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Unethical Practices
Posted by RHW on 01/27/2011
Recently by error a bank payment of $1908 was transmitted to CIGNA for a monthly payment on a life insurance policy. The amount due was $19.08. Soon as the error was discovered their customer service was contacted and said that they could not send it back. Even the bank representative could not get them to send it back to correct. I ask for a supervisor and was told there was none available. I ask for one to call me.

hours later I received a call and was told they could not return the amount. They said they could send me a form to fill out and request that it be returned and they would review and let me know what could be done. I said not acceptable. I owe them no money and they are holding nearly $2,000 of my money. They have had it for a week and if I waited for a form and followed their suggestion it could be weeks if ever before that money could be returned. Until and unless this $2000 is returned my home budget is in the red that amount. I have no idea what they plan to do with the money but they won't return it.

Now I must pay a lawyer to sue for me to try to get some of it back. With their unethical business procedure I question how reliable their product is. Shame on CIGNA.

     
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Posted by saj80 on 2011-01-27:
You can also file an ACH dispute with your bank, as you have time to do so, and it would be a lot less expensive than hiring an attorney.
Posted by Obsfucation on 2011-01-27:
She can't file a dispute, SHE sent the incorrect payment. Cigna is telling her that she must submit a form to request that the payment be returned. This is pretty standard, and if she moves on it, it doesn't take long. Rather than antagonize Cigna, she should try to get them to work with her for a quick refund.
Posted by BofAmerica666 on 2011-01-27:
You should be able to get the money back, because it was their error, and you have everytight to be upset about. If the amount is under $2500 you might be able to resolve it a small claims court, if you need to take it further. Good luck in anycase, let us know how the result.

Your review was very helpful, and I think we can all learn from these things.
Posted by Obsfucation on 2011-01-27:
No where does OP say it wss a bank error, she says that amount was sent in error, i.e. she forgot to put a decimal point in the online payment amount. If it was a bank error, all she'd have to do is point it out and the bank could reverse it because it was a bank error, and that is allowed.
Posted by CIGNAQuestions on 2011-01-28:
I'm sorry to read of your experience. Email your contact information to customeradvocacy@cigna.com and I will take a look.
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Cigna Medicare Access (PFFS) 2010
Posted by Conniern57 on 12/18/2010
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 Leger on 08/20/2010
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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Posted by 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.
Posted by skelly39 on 2010-08-20:
Contact the Dept of Insurance in your state and file a complaint.
Posted by 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?
Posted by 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 where 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 where 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.
Posted by Emily on 2011-11-07:
Thank you for sharing this info. I wish that everyone in Congress was reading this email now.
Posted by 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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