ComplaintsforCigna

• Initial Complaint

  06/26/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My insurance company Cigna is not paying the amount I was told they would pay. I called ahead to make sure what they covered as the conselor I was seeing is out of network. The representative on the phone said my out of network deductable is $500.00 and then the insurance would pay 60% after that. I have paid a total of $870.00 and they do not consider my deductable paid because they determine how much they are going to pay the counselor. So if they charge me 210 dollars a visit and the insurance says they are only going to pay 110 then take 60% off of that and apply it to my deductable. That is wrong. That is not how it was explained to me or I might have not chosen to go out of network. This is why people do not get the mental health care they need is because insurance doesn't not want to pay what they rightly should.

  Business response

  07/13/2023

  July 13, 2023
  
  BBB
  1411 K St. NW, 10th Floor
  Washington, DC 20005-3404
  
  Re: Customer: ******* ********

  Dear Sir or Madam:
  
  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry. We will notify your office, of the outcome, upon completion.
  
  Sincerely,
  
  ***** ************
  Senior Manager, Executive Correspondence

  Business response

  07/19/2023

  July 18, 2023  
  

  Dear Sir/Madam:  
  

  This is to advise you that ******* ********’s concern related to the processing of her  out of network claims has been resolved. The customer was notified via telephone  the claims processed per her plan’s benefits. She was given proper information  concerning her benefits prior to receiving them.  
  

  Sincerely,  
  Cigna's Office of Senior Leadership Escalations

  Customer response

  07/19/2023

  [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: We did not settle it.  All they did was argue and refuse to admit they told me several different ways they told me my benefits went.  Please see attatched.  I'm the only one seeing the counselor so out of pocket deductable there saying is $250 individual.  Why are they making me pay $500?  How am I suppose to know they pick and choose how my out of pocket maximum will be paid.  They can decide what they think how much the dr. appointments was worth paying instead of what the dr. actually billed.  The person would not listen to me at all just kept repeating herself like I was a little child. Very rude.  
  
  Regards,
  
  ******* ********
  

• Initial Complaint

  06/26/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have a Cigna ******** Advantage plan . My plan pays 100% up to $2000. I filed a claim for $124 and I only paid me back $48. They will do nothing to resolve my problem. They lied in writing and said it was resolved, but never actually did anything about it

  Business response

  07/13/2023

  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion.  
  
  ***************************
  Senior Leadership Escalations

  Business response

  08/10/2023

  July 27, 2023

  Dear Sir/Madam:
  

  This is to advise you that *** ********’s concern related to claim for $124.00 has been resolved. The customer was notified and advised of the outcome. I can confirm
  that a resolution letter was also sent to the customer on 07/24/2023.
  

  Sincerely,
  ***** ************
  Senior Manager, Executive Correspondence

• Initial Complaint

  06/19/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Patient went into hosptial for emergency tumor excision surgery, On-call surgeon requested intraoperative neuromonitoring from his preferred provider. Neuromonitoring team is out of network with Cigna, However per the 2022 "No Suprise Billing Act". Out of network providers at an in network facility on an emergency basis are to be processed in-network at the average in-network rate (called the QPA or "Qualified Payment Amount")For nearly a year, Cigna continues to tell the provider to bill the family for a service in violation of federal law. Provider has already appealed and had claim upheld. Please get in touch and rectify this case, get it off the patient's back.

  Business response

  07/06/2023

  Dear Sir or Madam:

  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry. We will notify your office, of the outcome, upon completion.  
  
  Sincerely,

  **********************************
  Senior Manager, Executive Correspondence

• Initial Complaint

  06/19/2023

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  This company will not stop calling me with there automated message. It have asked multiple time to be removed from the list and I am filling this out in hopes that I am finally not contacted by them ever again. They come off as a scam and just because of all the calls I would never use Cigna.

  Business response

  07/05/2023

  It has come to Cigna's attention that individuals are receiving suspicious robocalls from an entity falsely identifying itself as Cigna. The purpose of these calls seems to be to collect personal information or to market insurance products and services.

  These robocalls share the following characteristics:
  -Calls occur multiple times throughout the day.
  -Calls may come from different phone numbers.
  -Caller may request personal information under the false pretense that you are purchasing Cigna insurance coverage.
  -Automated recording may prompt you to "press 1 to speak to the operator or get your name taken off the list."

  These calls are not coming from Cigna or any Cigna partners. Cigna and its partners will identify themselves as Cigna or a representative of Cigna and will comply with the Federal Trade Commissions' National Do Not Call Registry.

  Protecting your privacy is very important to Cigna and Cigna partners. If you receive an unwanted or unauthorized robocall that claims to represent Cigna, this is likely a malicious or fraudulent call, and we advise you to take the following action:
  -Do not respond to the prompts or requests to share personal information, as this may cause additional calls.
  -Block the phone number(s) on your cell phone and/or through your carrier.
  -Report unauthorized/unwanted robocalls or other calls at one of the following federal agencies:
     -The ************************ at: **************************
     -The ********************************* at: *************************************

  Customer response

  07/06/2023

  [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,
  
  *************************
  

• Initial Complaint

  06/14/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My son got braces on 05/20/2021. I had 2 processed claims from Cigna back in November of 2022, saying they paid the orthodontist for my son's braces. I was in the orthodontist office 03/20/2023 and they confirmed they have not received any payments from Cigna for the claims. I forwarded them the 2 EOBs I had so they could reach out to Cigna and get their money. After they called Cigna they placed my son's claims back into a pending status saying they needed more information and a new agent must have processed the claims in error and they would be processed within 10 business days. Three months later and the claims still have not been processed, saying they just got the information on 06/01/2023. The claim they did process on 05/26/2023, the orthodontist still has yet to receive any funds for and when they call they have no record of it being paid. They keep telling me they need documentation that my son's secondary insurance isn't primary and I have provided them this information several times. I have also given them copies of court documents showing I have custody of my child and I am to carry insurance on him, which makes Cigna his primary insurance since it is my employer insurance. It should not take over 2 years to pay a claim. My other son received braces the same day and they paid all of his claims with no questions asked.

  Business response

  06/28/2023

  June 28, 2023
  
  Better Business Bureau
  1411 K ST NW, 10th Floor
  Washington, DC 20005-3404
  
  Customer: *************************
  Tracking ID: **********  
  
  Dear Sir or Madam:
  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry. We will notify your office of the outcome upon completion.  
  
  Sincerely,
  
  **********************************
  Senior Manager, Executive Correspondence 

  Customer response

  07/07/2023

  [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,
  
  *************************
  

• Initial Complaint

  06/10/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Cigna's Orthodontia plan stated that Cigna would cover up to $1000 of my treatment. The monthly premium is $34. My plan became active on September 1, 2022. I called Cigna customer service and spoke to a representative who confirmed that could start my treatment since my plan was active. To begin treatment, I visited Smiles Forever orthodontics office on September 12, 2022. They contacted Cigna and confirmed that they would cover $1000 of my treatment and set up a payment plan with me. My treatment was expected to take 10 months. Since September 2022, I have been charged $34 monthly. In June 2023, I received an email from the orthodontist office."As a service to our patients, we assist you in receiving benefits from your insurance company. This email is to inform you that we have received notification from Cigna that they are going to pay $0.00 towards your orthodontic treatment rather than the $1,000.00 that we estimated at the start of treatment. This is due to a 12 month waiting period that was not on the verification we received at the beginning of your current treatment on 9/1/2022. A balance of $1,000.00 remains unpaid by Cigna, and will be added to your financial obligation. See the 2 verifications attached. The 2022 verification not showing the 12 month waiting period and the 2023 verification showing the 12 month waiting period. Cigna has paid $417.40 towards your treatment to date. However, per our conversation with ***** at Cigna on 5/24/2023, Cigna will be asking for that to be refunded back to them. This is why we are asking you for the full $1,000.00 payment."The 12-month waiting period was never disclosed to me, and I would have never signed up for the plan had I known. Cigna's customer service refuses to let me cancel my plan, as they keep transferring me to different departments. As a solution, I want a full refund from Cigna for the $34 charges for 9 months, totaling $306, so that I can pay my orthodontist.

  Business response

  06/27/2023

  June 27, 2023
  
  Better Business Bureau
  1411 K ST NW, 10th Floor
  Washington, DC 20005-3404
  
  
  Complainant: *************************
  Tracking ID: **********
  
  Dear Sir or Madam:

  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry. We will notify your office of the outcome upon completion.  
  
  Sincerely,
  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  07/06/2023

  [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 called Cigna on June 29, 2023 and finally had my plan canceled. However, I am seeking compensation for the ten months that I was charged $34/month. September 2022 -June 2023. I was falsely told that Cigna would cover $1000 for my braces after my plan became active on September 1, 2022. That was not true. I received no assistance from Cigna.
  
  Regards,
  
  *************************
  

  Business response

  07/26/2023

  July 26, 2023
  
  
  Better Business Bureau
  1411 K ST NW, 10th Floor
  Washington, DC 20005-3404
  
  Complainant: *************************
  Complaint ID: ********    
  
  Dear **************:

  Thank you for your patience. We can confirm that the Cigna Dental **** plan does offer orthodontic coverage; however, it is subject to a twelve-month waiting period. This waiting period is not eligible to be waived, regardless of prior coverage. This is outlined in the summary of benefits, and it has been confirmed this document was issued to ************** on September 5, 2022.
  
  Cigna's Individual and Family Plan (IFP)) department conducted a comprehensive review of her concerns with the  IFP sales, claims, and benefits team regarding this matter. It was determined that she was not advised that the plan had a waiting period. Due to the omission, IFP have granted an exception to waive the waiting period for the orthodontic services. Please note, all other plan provisions have been applied. We can confirm that her claim for date of service January 1, 2023 - $1,278.34, claim # *************, for services rendered by ****** ******* ********* *** was processed at the in-network benefit level on July 10, 2023.
  
  Cigna's Senior Leadership Escalations Office released a detailed resolution letter to *** ***** on July 26, 2023, to the address on file.
  
  Sincerely,
  Cigna's Senior Leadership Escalations Office

  Customer response

  07/26/2023

  [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: In the response from Cigna, they stated that the 12-month waiting period would be waived however, I was able to terminate my plan with them on June 29, 2023. I am no longer seeking their service. I am seeking compensation for the 10 months (from September 2022 - June 2023) that I was charged the $34 premium as I received no benefits from them. That is a total of $340 that I am requesting to receive back no later than August 9, 2023. 
  
  Regards,
  
  *************************
  

• Initial Complaint

  06/09/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I filed a claim for an injury that occured January 1,2023 Claim #********** I have given the company all of the supporting documents and phone numbers to reach the providers of service. This is a claim for supplemental accident insurance. I have logged over 12 hours in phone calls to their ************** claims number and been told I'd be called back dozens of times.No one will give me any response to my claim other than that it's processing and claims typically take several weeks to process. It has been months with no attempt from them to resolve this matter.

  Business response

  06/27/2023

  June 27, 2023
  
  Better Business Bureau
  1411 K ST NW, 10th Floor
  Washington, DC 20005-3404
  
  Complainant: *****************************
  Tracking ID: **********  
  
  Dear Sir or Madam:

  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry. We will notify your office of the outcome upon completion.  
  
  Sincerely,
  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  07/06/2023

  [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 filed a claim in January and they just sent me a request to file a new claim today. They're totally disregarding my original claim and forcing me to file a new one and gave me a deadline or they would cancel the claim after Ive waited months to receive a response. 
  
  Regards,
  
  *****************************
  

  Business response

  07/21/2023

  July 21, 2023
  
  
  Better Business Bureau
  1411 K ST NW, 10th Floor
  Washington, DC 20005-3404
  Complainant: *****************************
  ID: ******** 
   
  Dear **************: 
  
  We can confirm that the letter with the new claim form was sent to ****************** on June 22, 2022. Cigna did not receive ******************'s BBB complaint until June 26, 2023, and at that time Cignas Supplemental Health Solutions (SHS) began their investigation into the matter. 
  
  ********************'s claim was missing necessary information. We can confirm that a representative with SHS outreached to ****************** on July 10, 2023, in order to obtain the necessary information. 
  
  We can confirm that the claim was adjudicated, and a check was released to ****************** on July 14, 2023.  
  
  Sincerely,
  
  Cigna's Office of Senior Leadership Escalations

  Customer response

  07/25/2023

  Cigna has reached out to me and resolved this matter.

• Initial Complaint

  06/08/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  6/08/2023: I went to the Emergency room today for pain and was given a prescription for pain. I went to the pharmacy and was denied the medication for failure to pay premium. I called Cigna and made a payment. After making the payment I was told it would take 48-72 hours to update the account. I advise of extreme pain and pleaded, was transferred several times, kept on hold indefinitely and eventually told by a supervisor named ******* that nothing could be done since the account needed to update. I check my **** ******* account and the payment was taken out of the account today, right now there is a charge for the premium in the amount of $85.30 however according to their system, the bill still isn't paid and I cannot get my medication. Because it is a narcotic, the pharmacy will not allow me to pay cash for drug. I am left in excrutiating pain because of this!!!! I am in so much pain right now. I am in agony and it needs to be noted how the Carrier treats their members that hold individual plans through the marketplace! Dispicable service, I am so wounded right now both physically, emotionally, I feel terrible. Reference numbers for the conversations: ******** (billing dept that took my payment) & **** (supervisor *******)

  Business response

  07/12/2023

  July 12, 2023
  
  Better Business Bureau Serving Metro Washington DC & Eastern Pennsylvania
  1411 K Street NW, 10th Floor
  Washington, DC 20005
  Attn: Dispute Resolution Department 
  
  Tracking ID:  ********
  Complainant: *********************************
  
  Dear Sir/Madam:
  
  This is to advise you that ******** ********'s concern related to medication order has been resolved.  According to **. ********* prescription history, the two medications in question were obtained from the retail pharmacy on June 8, 2023.
  
  Sincerely,
  
  **********************************
  Senior Manager, Executive Correspondence

• Initial Complaint

  06/08/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Incorrectly denied claim. I've spoken with numerous representatives and supervisors. After posting a review on ********** a person from PR contacted me. Her research indicated that the plan contract language was clear that the claim should be covered. (When I spoke to *** with a customer service person the *** person was using the wrong contract. I have spent hours on the phone going in circles. It is by design.) She sent it back to *** who had incorrectly denied it three times. Weeks have passed with no action. This is a common pattern where Cigna folks are looking into it, get no where, then drop it and nothing gets done. I would like this claim covered, that is processed correctly.

  Business response

  06/26/2023

  June 26, 2023
  
  BBB
  1411 K St. NW, 10th Floor 
  Washington, DC 20005-3404 
  
  Re: Customer: *************************
  
  Dear Sir or Madam: 
  
  Cigna is reviewing this matter and will be working directly with the complainant to resolve the inquiry. We will notify your office, of the outcome, upon completion. 
  
  Sincerely, 
  
  **********************************;
  Senior Manager, Executive Correspondence
  
  

  Customer response

  07/07/2023

  [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 cannot tell from the response from Cigna 9see: above) what they are doing. Who is the complainant? This morning I received a phone call from the Satisfaction department. They are understanding the problem and are now harassing my physician. The problem is that I was not given correct information when I called about the payment amount for my provider, i.e., doctor.  The wrong information is, the amount paid for the claim, is incorrect on My Cigna.com. I haven spoken with multiple Cigna employees with the same question that is, Is the omen on Cigna.com for this claim being sent or has it been sent to my physician. I was told yes by more than one Cigna employee. After too many phone calls I am told this morning a completely different version of what the problem is. So, getting clear and explicit information from Cigna is important. In addition, this claim was incorrectly denied three times. ASH was administering a different plan, than the health plan contracted. They are NOT handing any of these problems. 

  Regards,
  
  *************************

  Business response

  07/24/2023

  July 11, 2023  
  

  Dear Sir/Madam:  
  

  This is to advise you that ****** ******’s concern related to the amount paid to the  provider has been resolved. The customer was advised the amount listed on the claim  is correct per our contract with ******** ********* ****** (***). The provider’s  contract is with *** and not with Cigna. Any dispute concerning the amount paid to  the provider by *** will need to be between the provider and ***.  
  

  Sincerely,  
  Cigna's Office of Senior Leadership Escalations 

  Customer response

  07/24/2023

  [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:  Again, when I spoke with Cigna Customer Service representatives I was told that an amount that was $20. more would be sent to my provider.  That is, the allowable amount matches what is posted on the Cigna website EOB as payment to provider. In that conversation I was very clear and repeated my question would $93.--be sent to my provider and gave his name, name of practice, and address.  I stated more than once-Is that correct? I was told, "yes". I asked for that to be confirmed and was told that a supervisor would call me within 24-48 hours which did not happen. When I spoke with a person from the Executive office I was told that the provider was ***. In the letter submitted to BBB  by the Executive office the provider is now my physician. These facts matter when one is trying to get correct information. When speaking with the Executive office representative she was adamant about this definition of provider.  In addition, members are not allowed to speak with ASH.
  
  It does not seem to matter to Cigna that this claim was incorrectly denied by *** three times ( 2 appeals were denied) and they were using the wrong contract to administer benefits. The contract information comes from Cigna. So, ultimately, it is the responsibility of Cigna to insure that they are correctly administering benefits whether or not some of these benefits are contracted out to a third party administrator.  It took someone from the Social Media department to get the truth.  This is tangential, but my conversation with the Executive Office was less than stellar. After a member has had a series of negligent mistakes and complete disregard I was hoping for a more relational and respectful conversation.
  
  Regards,
  
  *************************

  Customer response

  08/01/2023

  8/1/2023

  I received a letter from Cigna today re: this situation. Again, they are not addressing the problem(s). I was given inaccurate information from multiple people re: payment amount to my provider. The wrong amount is posted on Cigna.com. When i phoned customer service to clarify and confirm the amount and who it went to I was not given the correct information. I requested a supervisor contract me to double confirm. No one from Cigna called me. The definition that Cigna uses for a "provider" changes. In the letter I received today, dated July 26, 2023 my provider for this claim was referenced as a physical therapist. He is NOT a physical therapist, but a physician. Again, the truth is important to Cigna. This claim was incorrectly denied three times. *** was using the wrong contract to process claims. Even in the letter I received today they refer to this plan as a Cigna plan. It is not a Cigna plan/policy. They can rename it, but it is not a Cigna plan. it was not written by Cigna and the contract with my employer and Cigna is for Cigna to be the administrator of this already existing plan. This means that they administer the plan as written. The only that can be changed is the allowable amount. This can be "enhanced, but not decreased." None of this matters to Cigna.  I spent over a year trying to get this claim processed directly. The billing department wrote two appeals that were denied incorrectly. I posted a complaint re: this claim on a website and someone from their (Cigna) social media department looked into it and confirmed that *** was using the wrong contract and that indeed I was correct about my contact language and this benefit. After speaking with more than 10 people to get the claim processed according to my health plan contract one person who had worked there approximately two months was able to get to the truth and find the exact page the reference the specific benefit. Cigna wasted so much time for so many people and continue to conduct business in this manner. Not to mention that members have not been able to access many of their benefits. There is not accountability, integrity. or oversight happening. And for what it is worth this health plan was for front line workers in the pandemic. In this letter received today it states, "we will not review this claim again." That is their choice, but Cigna did not process this claim correctly, without outside intervention, made over a year of mistakes, and have made no corrections.  

  Business response

  08/17/2023

  July 26, 2023  
  

  Dear Sir/Madam:  
  

  This is to advise you that ****** ******’s concern related to the processing of her  claims has been resolved. The customer was sent a Final Determination Letter on  07/26/2023. She has been advised once again that the provider does not have a  contract with Cigna. If the provider is disputing the amount paid to them on the  claim, they will need to contact ******** ********* ****** as their contract is with  them and they are the one’s that paid them. Cigna will not review this claim again.  
  

  Sincerely,  
  Cigna's Office of Senior Leadership Escalations

  Customer response

  08/17/2023

  [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: As previously explained, Cigna contracts with *** to process a portion of their claims. *** follows the directives of Cigna. Cigna is responsible for providing the correct contract and information re: how to administer benefits. Cigna directs *** to not speak with members so it was not possible for me to work with them. As previously stated I had a three way conversation with a Cigna customer rep. and an *** employee. At the end of a very onerous conversation the fact that *** was using the wrong contract to administer benefits to members on this plan was discovered, but *** and Cigna were not willing to do anything about it to process my claim correctly.  Prior to this I had been working with  Cigna supervisor for months who just dropped the case which has been my ongoing experience with trying to get eligible claims covered correctly. I made a complaint on social media and someone for the social media department at Cigna contact me. They were able to locate the correct contract and find the benefit in question. Cigna and *** had been incorrectly handing this benefit for a years time. There is no reason that they could not have handled the claim according to the contracted agreement other than they just do not want to pay. To state that they have no responsibility for *** claims is not accurate nor ethical. I am very concerned that this is allowed or legal in this country. I have had multiple conversations with Cigna, the Cigna liaison to my insurance plan and my union and employer re: this and Cigna is responsible for claims processed by ***.  My employer has terminated the contract with Cigna for a reason. This is unprecedented in the history of health insurance benefits with my employer. 
  

  Business response

  09/13/2023

  September 13, 2023
  
  Better Business Bureau
  1411 K ST NW, 10th Floor
  Washington, DC 20005-3404
  
  Complainant: *************************
  
  Dear Sir/Madam:
  
  This is to advise ******************** complaint concerning her claims has been resolved. A final determination was mailed to the customer on 07/27/2023.  The claims have processed correctly per the customers benefits and the providers contract with ******** ********* ****** (***). *** has paid 100% of the contracted rate to the provider.  Cigna will not respond to this issue again.
  
  Sincerely, 
  
  Cigna's Office of Senior Leadership Escalations
  
  *****************************
  Operations Lead Analyst, Service Delivery & Communications

  Customer response

  09/13/2023

  This is not resolved on my end. An eligible benefit was incorrectly denied more than three times. Many Cigna and *** employees were not able to correctly administer this claim. *** admitted that they were using the wrong contract to process and **** claims. It took someone from the social media department to actually try to look into what went wrong. She told me that I was correct and that my words matched the contract. She contacted *** and explained to *** that they need to use the correct contract and that this was a covered benefit and that there were no ground for denial. This was not an easy process for her. In other words, Cigna did not set up systems to process claims correctly with this employer's health benefit contract. Cigna and *** are both responsible for correctly administering benefits. In addition, the information on their website for members has unclear and incorrect information. I phoned to clarify terms and what the exact benefits were and how they had been covered. The information I was given was incorrect. This resulted in having the wrong amount identified as the edible benefit amount. Getting any correct information and benefits covered correctly requires hours into the double digits to get Cigna to do their job. It is by design and egregious. This may be resolved on their side as it is intentional so they do not have to pay. Simple as that. 

• Initial Complaint

  06/07/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Cigna claims they were never contacted about a claim for annual lab work at quest. I was given the bill $433. Quest says they sent it 3 times. I put in a complaint against quest already. The lab work was completed on 8/22/22. My coverage with Cigna started on 8/1/22. I have called both sides 3 times to get this matter resolved. have a phone number for my 3rd party administrator **************. Today I received an EOB from Benefit Management. Their phone number is ************. I'm tired of getting the run around and spending lunch breaks on hold to resolve this matter.

  Business response

  06/26/2023

  Cigna is reviewing this matter and will be working directly with the complainant to resolve this inquiry.
  
  We will notify your office of the outcome, upon completion.
  
  Sincerely,
  
  *********************
  Senior Leadership Escalations
  

  Customer response

  07/06/2023

  [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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