ComplaintsforCigna

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Initial Complaint
10/11/2021
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I took a rapid covid test on 12/23/2020. I called Cigna before getting this test to confirm I would be reimbursed for it. They said whether in network or out of network, Cigna would cover the cost of the test. I have been calling them for almost a year now trying to get reimbursed the $250 that they owe me. I have provided the super bill with the provider contact information, the tax ID, ***** and **** codes. They numerous times kept telling me they didn't have this information, when in fact, I provided the super bill to them. Each time I called they kept telling me for whatever reason, the provider information wasn't entered into the claim. I've been on the phone with a woman named ****** (Manager at Cigna) who has now told me the claim has been processed but I'm only eligible for $148. I was originally told the test is fully covered and I want the full $250 back that I am owed.
Business response
10/20/2021
Hello *******,

Cigna is reviewing this matter and will respond with additional information.

We take patient confidentiality seriously

Protecting our customers' personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individual's private health information (PHI). Because this matter requires that we look into personal information, we need her to give us permission to share our findings with the Better Business Bureau. ******************************* can grant this permission by signing the attached Authorization for Use and Disclosure form.

Thank you,

Christine A****
Executive Office Advocacy Team
Customer response
10/21/2021
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

They also emailed me with this document. I signed and sent back to them. Please see attached.

Regards,

*******************************
Initial Complaint
10/07/2021
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Hello, I am seeking help for the lack of payment that the organization Cigna is doing. They’re trying everything unethical tactic to not pay my claim for being off work sick. I have doctors notes to support my claim. They have admitted to requesting wrong information on a recorded call several times. This is not my fault that that can’t get their staffed trained. I have been under a significant amount of trauma within the last 100 days. Including the loss of my Son and Grandmother, two close cousins. Conga has added to this stressful situation by evading payments. I pay for this service through my employer and should not have to suffer paying bills and funeral services, because they want to not pay legitimate claims.
Business response
10/26/2021
October 26, 2021

Dear ******* *****,
We are writing in response to your October 15, 2021 correspondence and the accompanying information from ***** ****** about his claim for Short Term Disability (STD) benefits under the above named policy.
*** ****** expressed concerns over lack of further STD benefits having been paid to him under the above policy. The policy under which *** ****** is covered requires proof of loss and proof that he meets the policy’s definition of disability. The policy’s definition of disability is a functional definition, which requires proof that *** ****** is unable to perform the material duties of his regular job due to injury or sickness. Because conditions can change and improve with treatment, once a claim is approved, the policy requires ongoing proof of disability in order for STD benefits to continue.
While *** ******’s claim was approvable for a time, as of September 3, 2021 the determination was made that he would no longer meet the definition of disability beyond July 21. 2021. Our claim staff had requested and obtained updated medical information, including both office visit notes and restrictions and limitations, from the treating providers *** ****** identified. This information was reviewed with our medical staff, who provided their opinion on the level of functioning reflected in those records. Based on this, the determination was made by our claim manager that *** ******’s claim would be denied for further benefits.
Detailed letter was sent to *** ****** providing our decision rationale dated September 3, 2021. In addition, this letter included his appeal rights. Our records also indicate that our claim staff continued to engage *** ****** after his claim was denied to ensure his questions were addressed. Calls with *** ****** are documented as having occurred on September 3, 10, 13, and 2021. We received *** ******’s appeal request on September 13, 2021, at which point his entire claim file, including additional information received after our September 3, 2021 decision, was sent to our appeal team for a separate and thorough review. That review is still ongoing at this time, after *** ****** confirmed by phone on October 13, 2021 with our appeal staff that we may proceed with our review.
We understand that *** ****** remains frustrated with the denial of his claim, and disagrees with the outcome. We are committed to full and fair claim reviews, and are confident that he will receive the  thorough reconsideration of our decision that he is seeking through our appeal process. Should he have any questions, he may reach his appeal specialist by calling ###-###-####.
Last December, *** **** **** ********* ******* entered into an agreement to acquire Cigna Group Insurance (CGI) your provider of employee group disability insurance. Today, we want to share the news that the acquisition is complete, and we are now *** **** **** Group Benefit Solutions.
We wanted to make sure you were aware of this change to avoid any confusion, as you will start to see or hear references to the new company name, *** **** **** Group Benefit Solutions in place of “Cigna Group Insurance.” Aside from a change in name, you should not notice any other changes. The service teams who support you today are not changing. Please continue to use the same contact information, phone numbers, and service sites, such as mycigna.com.
Sincerely,
Eric
Compliance Specialist
Customer response
10/29/2021
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]

Complaint: ********

I am rejecting this response because: Cigna has a bad reputation for how they conduct business. The managers are very unskilled at their jobs and are not qualified to assess medical claims. This has to be done by a qualified board certified health care professional. I have added the below content to prove that this company is very shady and does not operate with any integrity and doesn't like to pay claims.
***** ********* *** ***** ****** ****** ** *** ** *** ************ *** *************** ********* ** ***** ******* *** ********* ********** ********** ***** ****** ******* ***** ** ********* ******** *** ****** ********* ***** ********* **** ********** *** ****** *** ************** ** ***** ****** *** ****** ******* ***** *** ********** ****** *** ******** ***** *** **** ******** ** ********** *** ********** ******** *** ********* **** ********* **** ***** ******* ** ******** *** ******* ** * ****** ** *** ****** ***** ********* *** ******* *** **** *** ** ******************** ********* *** ************** ****** ***** ***** ************ *** ******** ***** ******** ********* ******** *********** ************ ** ****** ** ********* ********** ******* ** **** ** * *********** ***** ***** ** ** ******* *** ********* *** **** ******* ** ***** ****** *** ********* *** **** ********** ******* *** **** ** * ******* ******** ******** ****** ***** ******* **** ***** *** ********** ******* ********* ** ********* ********** ******** *** ****** ******* ******* ***** *** ********* ********** **** ******* ** ***** ******** ********* ****** ********* ****** ******** *** **** ******* ** ************** *** ***** * ***** ****** **** ***** * ***** ****** ******* ** ********* ******* *** *** ******* ** ****** ** ******** *** ******** ************* ******** ******** ************ ************ ************ ******** ****** ******* ******* ******** *** **** ******* ** ********* ******** ************** ****
Regards,

***** ******
Initial Complaint
10/01/2021
Complaint Type:
Order Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On July 16th 2021 I had my wisdom teeth extracted. Before I attended this appointment I contacted Cigna on three separate occasions to confirm that, following the procedure, that Cigna would be paying for the extraction based on the pre-authorization that had been completed between my dental office and Cigna. Following the procedure I was informed that it is most likely not going to be paid for by Cigna. The character count on this form does not allow me to prove all information, but I have attached a document with a breakdown of all of the phone calls I have had with Cigna, the representatives names, the dates and direct quotes from the conversations I had, where almost all representatives have mis-informed and mis-guided me on my policy, and basically stunted my ability to select suitable medical care as it pertains to my policy and Cignas fiscal responsibility. Please see attached documents for breakdown of complaint and policy information. Kind regards, *** ******
Business response
10/07/2021
Cigna is reviewing this matter and will respond with additional information.

We take patient confidentiality seriously. Protecting our customers’ personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individual’s private health information (PHI). Because this matter requires that we look into personal information, we need them to give us permission to share our findings with the Better Business Bureau. ***** ****** can grant this permission by signing the attached Authorization for Use and Disclosure form.

Bradley G*****

Executive Office Advocacy Team
Customer response
10/13/2021
A manager from Cigna contacted me to inform me that Cigna would be covering the disputed claim. The manager highlighted that I was covered all along and tried to push blame onto my partners employer for the complexity of my policy. I am happy that Cigna has met their obligation and responsibility as an insurance provider, but I don't doubt that it was this BBB report that got the job done. Had I let them deal with the situation themselves, this would have been going on for months; as is their standard practice. And as a result of their poor training and mishandling of claims, I have now been informed that my dental provider is going to be dropping them as a preferred medical insurance. Maybe once they start losing money, they might start just doing the right thing in the first place.

Thank you for finally processing my claim, but please do better, Mr Big Insurance Company that doesn't care about providing health insurance to it's customers.

***** ******
Initial Complaint
09/16/2021
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I have a serious medical condition of hyperlipidemia, am statin intolerant due to my recent critically high CK reading, and it seems that Cigna, instead of allowing me a treatment for this condition, just stonewalls me and expects me to walk away quietly untreated and die. I do not think that is proper for a health insurance company to essentially expect a patient to die by not allowing him proper treatment. For example, my PCP Dr ********* wanted me to take Nexletol, and Cigna refused to cover it despite Dr********** filing for prior authorization. Now I am scheduled to see a cardiologist Dr**********, and expect him to want to inject me with Repatha, which I just found out is also not covered and needs prior authorization. I also asked Cigna for a patient representative or a case representative, and again said that I do not qualify. An ounce of prevention is better than a pound of cure. I just wish Cigna adhered to that adage! Instead, it seems a penny saved for tomorrows heart attack
Business response
10/26/2021
Cigna is reviewing this matter and will respond with additional information.

We take patient confidentiality seriously

Protecting our customers personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individuals private health information (PHI). Because this matter requires that we look into personal information, we need him to give us permission to share our findings with the Better Business Bureau. ***************************** can grant this permission by signing the attached Authorization for Use and Disclosure form.
Business response
11/15/2021
Thank you for forwarding this complaint to Cigna. Cigna has reviewed this complaint regarding ***************************** concerns about their denied authorization. I can confirm on November 4,2021, the customer received a verbal resolution. The customer will work with their provider to confirm all necessary documents are submitted with the new authorization request.

Thank you again for sharing your concerns with the Executive Office at Cigna.

Sincerely,

*****************************
Executive Office Advocacy Team
Customer response
11/20/2021
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]

Complaint: ********

I am rejecting this response because:
On or about November 4, ***************************** of Cigna reached out to me to explain the next steps after Cigna's denial of Nexletol and Repatha. She said that my cardiologist Dr.***** had been informed that Cigna needed proof of heart disease before they can approve Repatha. Cigna wanted me to get a CT scoring scan (*****) of the heart to do this. During this conversation, I asked ********* whether Cigna would cover this procedure and she said yes.
Unfortunately, when my Dr.****** applied for prior authorization for this procedure, Cigna refused to cover it (see attached denial by Cigna). This seems to not only contradict what ********* had told me, but also seems to be another decision from Cigna that prevents me from staying healthy. I also find it odd that Cigna requests me to get the procedure done, while at the same time they will not cover the procedure.
Anyway, I proceeded to get the procedure done anyway on November 11, and was denied services because they said my heart rate was too high. It was at 80 bpm, where the threshold for the requested procedure was 75 bpm.
I thought health insurance was about promoting being and staying healthy and preventing a catastrophe. Instead, it seems that Cigna has a very low value on my life and is doing a lot to prevent me from staying healthy. I find it odd that a company that is supposed to promote health behaves this way for such an easily preventable condition!
I have a very serious medical condition, am allergic to statins, had have been left untreated for 8 months now.
Consequently, I do not accept Cigna's response.
*****************************
Regards,

***************************
Initial Complaint
09/15/2021
Complaint Type:
Order Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Good afternoon: We have been trying to get paid from Cigna on a surgery from 7/29/2020. The orthopedic co surgeon was paid but the Neurosurgeon hasn't been. We submitted a bill for $130,000 for Claim ID ************. The first procedure of ***** has been paid but ***** is denying despite the fact that it's billed with correct modifiers. Dr. ***** has been paid. According to pre surgery financial clearance we did not need an auth for this code. 7.) Spoke with: **** *-Ref: **** 8.) CPT Codes: ******** “Pre-cert. is required” ***** “ No Authorization Needed” Can you please help us get paid. We have called and received numerous reference numbers however we are getting a run around over and over. The rule is if one co surgeon is paid the other must be paid as well @ 62.5 %. Thanks!
Business response
09/17/2021
Cigna is reviewing this matter and will respond with additional information.

We take patient confidentiality seriously

Protecting our customers’ personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individual’s private health information (PHI). Because this matter requires that we look into personal information, we need her to give us permission to share our findings with the Better Business Bureau. ****** *. can grant this permission by signing the attached Authorization for Use and Disclosure form.

Thank you,

Christine A****
Executive Office Advocacy Team
Customer response
10/04/2021
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Regards,

****** *
Please see attached patients signature requested for appeal. TY
Initial Complaint
09/12/2021
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I am a retiree. I was paying for private health insurance through my former employer. Cigna was the plan administrator. After I turned 65 I filed for Medicare. I was told by Medicare that Plan B would start 7/1/2021. Since I needed to keep coverage, I continued to pay for my private insurance through my employer. I had some claims from 8/2020 through 6/15/2021 for medical coverage. There were 3 in particular that the providers called Cigna to determine whether there would be coverage and what my copays would be. I paid the copays for all three.I had the services provided done. The claims were submitted by the medical offices. One was for adaptations needed for my power wheelchair and the other two were for cataract surgery for both eyes. I started getting statements showing I owed thousands. I contacted Cigna several times to find out why. I was told that since I hadn’t enrolled for Medicare I owed what Medicare would have paid. I told them I couldn’t start until 7/1/2021.
Business response
09/17/2021

We take patient confidentiality seriously. Protecting our customers’ personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individual’s private health information (PHI). Because this matter requires that we look into personal information, we need her to give us permission to share our findings with the Better Business Bureau. **** ******* can grant this permission by signing the attached Authorization for Use and Disclosure form.
*****************
Executive Office Advocacy Team
Initial Complaint
09/09/2021
Complaint Type:
Customer Service Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
HORRIBLE CUSTOMER SERVICE - Unable to obtain an explanation as to their claim processing without 5 transfers and total of 2.43 hours on the phone being transferred to the incorrect team. When I finally got someone on the phone I was denied the possibility of speaking with a supervisor or to be given a provider representative. I would not have had to call if they had sent an explanation.
Business response
09/14/2021
Cigna is reviewing this matter and will respond with additional information. We take patient confidentiality seriously Protecting our customers personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individuals private health information (PHI). Because this matter requires that we look into personal information, we need her to give us permission to share our findings with the Better Business Bureau. **** *** can grant this permission by signing the attached Authorization for Use and Disclosure form. ***** ***** Executive Office Advocacy Team
Initial Complaint
09/07/2021
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
My son ************************* went to urgent care on 7/16/21. Our health insurance Cigna card indicates that there is a $50 copay for urgent care. My son went to urgent care, paid the $50 and was treated. We later received a bill for $848.52. Cigna is indicating that the urgent care is out of network. Urgent Medical Care is just that, it is urgent. Our card indicates $50 copay. It is completely in appropriate to indicate that an urgent care is out of network. This is unacceptable. Cigna should pay ************ for the care received.
Business response
09/13/2021
Cigna is reviewing this matter and will respond with additional information.

We take patient confidentiality seriously

Protecting our customers personal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individuals private health information (PHI). Because this matter requires that we look into personal information, we need her to give us permission to share our findings with the Better Business Bureau. ***************************** can grant this permission by signing the attached Authorization for Use and Disclosure form.

We also would need ******** son's permission to release personal health information to her. ************************* can can grant this permission by signing the attached Authorization for Use and Disclosure form.

****** **************************************** Advocacy Team
Initial Complaint
09/06/2021
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I have been seeing a medical provider for PTSD since 2016. Every appointment is $340. Up until the end of 2020, the claim was being processed for all but 20 dollars, leaving me a responsibility of $20. CIGNA informed me that they had been mis-processing the claims all that while, and that in fact they were overpaying me. Mental health under my plan should be covered at 100%, but CIGNA is considering the visit as an outpatient visit. Now, they have changed my reimbursement amount twice, and are saying that it is based on the *** pricing and not my plan provisions because the physician is out of network. Mental health doctors are crucial and trust and well being is a necessity to have a normal functioning healthy mind. I am seeking the claims to be reimbursed per the original schedule and for the matter to be taken care of.
Business response
09/17/2021
Cigna is reviewing this matter and will respond with additional information.

We take patient confidentiality seriously. Protecting our customerspersonal health information is critical. So much so, that the Health Insurance Portability and Accountability Act (HIPAA) requires that we protect an individuals private health information (PHI). Because this matter requires that we look into personal information, we need him to give us permission to share our findings with the Better Business Bureau. ******* ******** ******** can grant this permission by signing the attached Authorization for Use and Disclosure form.

********** *************
Global Complaint Advocacy Team
Customer response
09/20/2021
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]

Complaint: ********

I am rejecting this response because:

I have filled out the Authorization for disclosure form . I am attaching this, and need to know if you are faxing the completed document to them

Regards,

******* ******** *********
Business response
09/24/2021
Thank you for forwarding this complaint to Cigna. Cigna has reviewed the complaint regarding the customer's claims applying patient responsibility in error and has corrected all affected claims. A resolution letter has been mailed to the customer on September 24, 2021.

*******************************
Global Complaint Advocacy Team
Initial Complaint
09/01/2021
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On 4.20.21 I went to **** ********* ****** Medicine in East Nashville to see Dr. ***** *******. Dr. ******* is on my plan and he is my pcp. It appears that the visit went toward my deductible instead of being paid by Cigna with the exception of my copayment. I have contacted Cigna and the provider but I have no answers about why the claim was partially paid with a balance to me of $131. The visit falls under the parameters of preventative care.
Business response
10/11/2021
** Tracking: **********
Good morning,
A written response was sent to the customer on September 15, 2021. Cigna advocate failed to follow up with the BBB.
The claim was originally processed correctly per the plan provisions in place at the time of service. The claim in question was reprocessed on September 16, 2021, as a one time exception to reduce patient responsibility to a $20 copay.
Thank you,
Kelly
Customer response
10/20/2021
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Regards,

****** ****

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