LAKEVILLE, MINNESOTA -- My child has PTSD and chemical dependency. Today I was informed that she is no longer is being denied to continue her day treatment. Family and her facility consoler all agree she has made good strides but is not stable enough and relapse will not then likely happen if she does not continue treatment. Without any notice we were told on at noon on a Friday that she can not attend day treatment on the upcoming Monday. There was no communications of this either written or calls in advance.
The only thing that can be done is an appeal (which will take up to 30 days). By that time, she will have more than likely relapsed or worse. With a very big household there are enough challenges without being stabbed in the back by a company which you pay high rates for on a bi-weekly basis. We never had these issues with BCBS or Medica. However our company went a cheaper route and cheap is what we got! I would like to see this medical company live up to what they claim to be in their commercials. You would think they would care about a child's well-being but I guess that is too much to ask from CIGNA!
, MISSOURI -- My husband has Cigna Health Insurance through work. In January 2013 he was diagnosed with Cardio Myopathy, and was told by his cardiologist that he would need an Internal Cardiac Defibrillator implanted. Due to a lot of Medicare fraud with these devices, the government has a 90-day MANDATORY waiting period before one can be implanted, during which time the doctor monitors to see if medication alone can help the condition. During that waiting period, most of these patients are prescribed by their cardiologist to wear a ZOLL Life Vest, which is an external vest worn that can shock the heart in case of sudden cardiac arrest.
My husband's cardiologist is an In-Network provider, as well as the hospital he uses. The ZOLL Life Vest is the ONLY device of its kind made in the entire world, so there are no other such devices to choose from, and this is a life-threatening condition without such a device. This device is also an FDA Class III approved device, so it is no way considered an experimental device, and MOST insurance companies pay for the use of this device as an In-Network device, since there are no others made, EXCEPT CIGNA!
At no time did Cigna advise either my husband or his cardiologist that they considered this device as an Out of Network device, and until ZOLL themselves sent us a letter alerting us to this, and informing us that they were appealing this decision, we had no clue.
I made a complaint on the Consumer Affairs complaint forum, and lo and behold I get contacted through them the next day from someone at Cigna who said her name was **, and that she would like to help us with this matter. To make a long story short, she was a troll for the company whose job is to go through these boards and act like they are so concerned and want to help you. Well I bit, and sent her the information she said she needed, and she sent me back an email stating she got the info and was already at work researching the problem.
Three weeks later, after hearing nothing back, we receive the final bill for what we owe to ZOLL, with the Out of Network charges, meaning they turned down Zoll's appeal, and again no one told us. I emailed ** again, and this time I am told that she has no access to my husband's records, while remember that she told me she was researching our case and had all of the info, and that she had kicked it up to another department and had heard nothing back. So surprise, she had just put in another request on the day I just happened to get the bill and emailed her asking her what was going on.
My husband had reached his out of pocket cap for the year BEFORE the ZOLL bill went to Cigna, so we believe that this is an arbitrary decision on their part to charge it as an Out of Network claim, so they won't have to foot the bill for the entire claim, since my husband always uses In-Network providers and services, and has not reached the cap for his out of pocket expenses this year. I fired back an angry email to this **, which probably is not even her real name, and told her that this was a scam by her company, and that she had openly lied to me from day one, in order to stall, hoping that our time for an appeal would be up.
I filed a complaint with the Missouri Dept. of Insurance, as well as our own appeal to the APWU, which is the union for the USPS that my husband works for, because I am done dealing with this unscrupulous company. They are now going to have to explain to the state where they get off claiming this ZOLL Life Vest is an Out of Network claim, when it is the only device of its kind made in the world, and FDA approved for my husband's condition.
In short (full details are below) Cigna debited our HSA account to pay claims in the total amount of $1566 in mid-February and March 1st of this year. They did not, however, pay those claims, and have admitted to this fact. It is now May 17th. The money has been gone from our HSA account for 2.5-3 months. Instead of simply crediting us the $1566 that they took so that we can pay our outstanding medical bills, they are 'investigating' what they did with the funds. They will give me no date by which our funds will be returned.
The nitty gritty details: My husband's employer began using Cigna as a health insurance provider in 2011. We also have an HSA for the first time this year. In mid-February I had 2 claims, one on 2-15, the other on 2-17. Our deductible had not yet been met so both of the claims were sent to our HSA account for automatic payment. At total of $1,566.07 was deducted from our HSA account for payment to the providers.
In early March I was told by one provider that they hadn't received payment and were trying to work with Cigna in order to verify an EFT payment. In late April I received a bill from the other provider showing no payment had been received by them either. I called Cigna on 4-27 and was told by ** that they were working with the first provider (I'll call them Provider A) to track down the payment. Provider A, I was told, was being connected with a Cigna online business site that would allow the provider to track down all necessary information themselves.
Re the payment to provider B, I was told that an EFT payment had been made and was transferred to Chase (who runs the HSA) for further information. Chase informed me that everything ** had just told me was incorrect and that once Cigna debits my HSA account Chase can no longer see what happened to the funds.
So I called Cigna back and talked to **. She supposedly put in a request to get information as to how payment was made to Vendor B. She said that she hoped to get a response that day, or the next day at the latest, and would call me the following day with news. ** did not call me back soon the afternoon of 4-28. I called Cigna and this time spoke with **. She could see ** inquiry but said it looked as if it went to the wrong department. She said that she would put in a new request for tracking and would call me back on Sunday or Monday. She did not call me back.
I called Cigna again on 5-1 and spoke with ** who sent me to ** who, before I could stop her, sent me to Chase where I was told the same thing I was told before--Chase can't help me once Cigna debits my account. SO, I called back to Cigna again and spoke with **. She said that she could not see a payment being made in her system and that 'we are waiting to hear from that department'. I was supremely frustrated at this point and asked for a supervisor.
I was given to a supervisor named **. He said that he would find out if funds were paid to vendor B. If not, the funds that were taken from my account would be credited. If a payment had been made he would get me the check clearing info. I thought finally, I'm getting somewhere. But I was wrong. When I spoke with ** again on 5-4 he said that he could not find any record of payment having been made to Vendor B. He said that he would update the service request so that the money would be credited back to my HSA. He said that he would have verification within 24-48 hours and would call me back by that Friday, May 6th.
** didn't call me on Friday the 6th or Monday the 9th. I left him a voice mail on the 10th and on the 11th. Late in the afternoon of the 11th I got a call from ** (apparently calling instead of **). She told me that the payment matter was still under investigation. Cigna did take the money from my HSA and did not pay the provider, but that Cigna couldn't figure out where the money went. 'When the mystery is solved we will credit your account.'
At this point I was fuming. I explained that I didn't care what Cigna had done with the money or that they needed to figure out the glitch in their system. They admitted to having withdrawn money from my account and having not paid the vendor. There is no reason for further delay, I said, pay me back! She was so sorry, she said, but they were 'working' on it and she couldn't give me a date by which I would be credited.
On 5-16 I touched base with Vendor A to see if their payment issue had been solved. Big surprise, it had not. they had gotten online with Cigna's Business Services site but all the information that they could see was 'payment was made on X date'. No payment details or an audit to show which account the payment went into. As the provider said, "Cigna has been less than helpful."
I tried to reach ** again and could not--only voice mail. So I called the main number and asked to speak to another supervisor. I was transferred to **. She listened to my story with a mixture of horror and disbelief. She kept saying, "that just doesn't sound right that we would have taken money out of your account, not paid the vendor and drug our feet in returning your money." She apologized for Cigna's behaviour and said that she would do some research, get things straightened out and call me the next morning.
5-17: ** didn't call me this morning. I called her and she returned my call. She said that she is working with the client service partner (my husband's employer?) and her financial services department. It is confirmed that no check went out to Vendor B yet, she cannot tell me when I will have my money back. I explained to her that, in my eyes, Cigna's actions translate to theft and said that if any banking institution took $1566.09 from my checking account and refused to return it I would have solid grounds for legal action--same here--and I'm considering it.
She said that she was working really hard to get this resolved...blah, blah, blah. I explained that I had gotten that same story from every person I have talked to over the previous 3 weeks and that as 'hard as everyone is working on it' nothing is being done. She said that she 'escalated' the matter to a higher level. I asked if she was the first person to 'escalate' the situation and she said yes.
If this is true, it's a clear sign of how terrible Cigna's customer service is. This should have been elevated to a high priority situation on 4-27 and should have been resolved within a couple of days. Instead, the issue was passed around and ignored. I'm not hopeful that dealing with ** will be any different. I told her that I read Cigna's Ethics Policy online and got a huge laugh about their dedication to 'fair treatment of customers' HA! I have never been treated so poorly by any company in my life. Frankly, never imagined that treatment like this was possible.
NOTE: I asked what was happening with the payment to Vendor A. She said the investigation is currently on hold until the matter with Vendor B is solved... assuming Vendor B issue is solved they will use the same template to solve problem with Vendor A. Again, ridiculous. As if everything at Cigna were being done by hand with pen and paper in a back room. If they can't work on issues simultaneously they are operating in the dark ages.
IMO, they are simply not in a hurry to refund my money because they don't have to be. And that's what makes me the most angry. We are financially well off, but I know that this kind of gross incompetence could wreck some families with big medical bills and shaky credit. Absolutely, totally and completely disgusted with Cigna.
The consequences of this clustered mess is that we have medical bills that are due, and in some instances past due that we will either need to pay for out of pocket (and therefore lose the advantage of paying with pre-tax dollars with funds from our HSA) or risk having damage done to our credit... all because Cigna has taken our money and refused to return it. If anyone out there in HR is considering using Cigna, I can say loudly and clearly RUN THE OTHER WAY if you value your employees, their time and their sanity.
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 orthodontia 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 Orthodontist of $2475 and an EOB from a dental insurer indicating treatment began in December 2013.
CIGNA's explanation of eligible orthodontia 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 orthodontia is approximately $6000, I have paid a portion and dental insurance will eventually pay the rest. NOWHERE does it indicate that FSA will be reimbursed to the member / client / customer based on date paid.
Per the IRS Orthodontia 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-lose-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 as 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.
WESTON -- This medical management and Medicare affiliate company offers many nice amenities, free exercise workout 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 leftover 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 wheelchair, was refused transportation because she, allegedly, had used up her transport quota.
Our agent was incredulous to explain this misinformation. He made a call to customer service said we would get a call. I got a voicemail. 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?
After cancer surgery I contacted Cigna to get pre-approved for purchasing a specific L7900 Durable Medical device. I was told it was approved and I should find an in-network provider by calling a long list of names. After much effort and research I found an in-network company that provided the device. Based on Cigna stating they covered the device I then purchased it. But now Cigna denies the claim and states the L7900 Durable Medical device is not covered by my expensive PPO health insurance. I appealed the denial and they still denied the claim. I did everything I was supposed to do by getting pre-approved yet they still denied it.
Cigna never called back when they said they would and dragged this process out for 4 months. I could attempt a second appeal but I can already tell Cigna is so screwed up and fraudulent that the appeal would be denied. Kaiser was so much better to deal with and I will be going back to them during my company's annual health choice. I am stuck paying for this device even though I would have purchased another device at a lower cost if I knew it was not covered. I don't have the time to get a lawyer and document everything that has happened, but from what I'm reading about Cigna someone should file a class action lawsuit about fraudulently misleading customers.
The company is incompetent and has fraudulently misled me into making the wrong decision. Worse, they do not acknowledge their mistake and try to repair the damage done. This is the first time I've ever been so disgusted with a company that I found it necessary to file a negative report and I've been around 50 years. It is unfair to unsuspecting innocent people that unwittingly may get insurance through Cigna. DO NOT GET INSURANCE THROUGH CIGNA!!! You will regret it!!! DO NOT INVEST IN CIGNA STOCK. Eventually Cigna's incompetence and fraud will be well known and the company will face its demise.
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 prescriptions 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. That's 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 emergencies until after 6 months or 12 months. In my mind I have insurance exactly for the reason of emergencies. 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 to 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 it's 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.
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 provider sent me a letter that 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 waiver of co-insurance and deductible. For years, this provider had waive 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 scheduled 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 them 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.
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?