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CIGNA to Settle Lawsuit Brought by California and Other States

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Sacramento, CACIGNA will pay approximately $70 million to settle lawsuits filed by California, Connecticut, Maine, Massachusetts and Pennsylvania over the company’s denied disability insurance claims. The lawsuit, which involved long-term disability denials, was filed against CIGNA Health and Life Insurance Company, Connecticut General Life Insurance Company and Life Insurance Company of North America. Regulators began an investigation into the company after complaints about policyholders having long-term disability denied.

The Central Valley Business Times (5/24/13) reports that officials investigating the companies found that workers did not properly consider reports and diagnoses of other organizations and medical professionals. This allegedly included disregarding the findings of independent physicians, Social Security Disability decisions and records provided by workers compensation.

Policyholders who had their claims previously denied may be eligible to be reevaluated. CIGNA will pay $500,000 in fines to the California Department of Insurance.

In this case, policyholders did not have to file a lawsuit because regulators stepped in, recognizing that there were some issues with how claims were being processed. Individuals who face such issues may be eligible to file a lawsuit, depending on how their insurance was purchased.

If they purchased the insurance themselves (that is, the insurance is not provided through employment), then if they feel their claim was unfairly denied, they can file a lawsuit against the insurance company. If, however, their insurance is provided through their employment, then their insurance is covered by ERISA and they must file an appeal with the insurance company first. Failure to file an appeal can result in the lawsuit being dismissed from court. Only after all appeal options have been exhausted can the policyholder file a lawsuit. But, the lawsuit can only be used to recover money lost as a result of the claim being denied. An ERISA-covered insurance policy cannot be subject to punitive damages.

Meanwhile, some insurance companies are also accused of not properly paying out death benefits to the beneficiaries of life insurance policies. According to Sierra Sun Times (5/7/13), audits have been conducted by State Controller John Chiang into a variety of insurance companies to determine if they improperly failed to pay death benefits, instead depleting cash reserves and then canceling the policy.


California Denied Disability Insurance Legal Help

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Posted by

I need to clarify that I am from the state of California. There was one time that my Blue Anthem card was used by OB. This was about 3 years ago. They used it because they had it from the time prior to Cigna. I just thought they used it because they had it not because I HAD to use it. Anthem was such a high deductible that it didn't cover the procedure that I needed and CIGNA covered it at that time.

Posted by

Cigna is going back on claims and taking money away from my doctors who are no contacting me. I am teacher and our district makes us take insurance even if we don't want to use it. I have been taking the lowest insurance possible for the last 3 1/2 years. I have just been using my husband's insurance through his work since it was better. It is Cigna. I did not know that I HAD to use both until I received a letter from Cigna asking me if I had another insurance. When I got the letter I did some research and saw that I did. I sent the information to them a year ago stating that yes I did have another insurance. That was a year ago. I didn't use the doctor again until March of this year 2014. In April 2014 Cigna went back 3 doctors appointments and took the money away. Then they took one away in May. These are 1 to 2 year old claims. My doctors took the old claim and submitted them to my primary (anthem) and they denied them because of time frame. After denial the doctor resubmitted to Cigna and now have denied it. How far can Cigna go back and deny? I had a surgery in April of 2011. Can they go back to that one? I can't get any answers from the insurance or health care provider. What are my rights?

Posted by

Cigna's timely submission of claims is 6 months. I am not sure why you did not tell this doctor that you had two insurances from the very beginning. Or why you didn't call Cigna to say "hey this doctor does not want to file secondary claims".. they might have helped you then. But to say now after 3 years you want Cigna to pay you now. I doubt they will do that. They won't do if for us providers. If we submit a claim after 6 months its denied and stays denied. Now if you have proof that these claims were submitted timely and you have saved the representatives name and reference number. You could possible get those paid. If they do get paid, make sure Cigna sends you the money and not the doctor. Of if they do pay the doctor, he will have to refund you.

Hope this works out for you.

Posted by

Is there a patient advocate at Cigna? Or anyone else who can help me? I'm thinking about taking them to small claims court. Can that be done?

When I had health insurance with Anthem BCBS, I had the direct line of a patient advocate. He was helpful in getting a med paid for by Anthem that they didn't want to cover. If I had a question or concern, I knew he was a phone call away and could put my needs into action.

At Cigna, I get the runaround every time I call. I'm placed on hold for up to 10-15 minutes, I'm told, "Everything's fine; the check is on its way", just to appease me and get me off the phone. It's always a lie. I've spoken to 9-10 different reps there - regarding the SAME unpaid medical claims - over a span of 7 or 8 weeks, and each of them has given me a different story.

I'm out $4650 because of the negligence of my medical provider, who never took my Cigna insurance card and never processed any claims through Cigna since 2010! She took only the Anthem BCBS card. (I had two insurance plans). While Anthem did pay most of each of the claims, I paid the rest via copay. However, the rest should have been paid by Cigna. But the claims were never sent to Cigna for payment. And I would have sent them myself for payment, but I never knew that medical provider was an in-network provider with Cigna contract. I never knew she accepted Cigna! They took only my Anthem card!

Whenever I'd go to ANY other medical provider who were in-network with BOTH Anthem AND Cigna, the medical provider's staff would send claims to BOTH insurance companies and therefore, I would owe NO copays - ever!

I'm trying desperately to recoup the money I've needlessly spent for so long, now that I know that she's an in-network health care professional who participates with Cigna. I was not told this and never knew until Aug. 2013, and I've seen her since 2010. I've been paying money to her since then to the tune of $4650!

She should have been submitting claims to Cigna all along, but she did not! Why did she not ask me for my Cigna card? Why didn't she submit claims to Cigna each time I saw her (which was about once per week for three years)? She told me that "We never submit two claims to two different insurance companies for one individual. It's too much work and a paperwork nightmare!" REALLY???

So now I'm running myself ragged, speaking to 8-9 Cigna employees who all give me different stories. In Sept., I mailed Cigna ALL the claim forms and info they requested. It was 185 pages long, took hours to research, find, print and organize and cost about $15 to send certified with a return receipt request. Someone at Cigna signed for it on 10/2/13. I STILL have gotten NO closer to resolving the claims. They have them, but they say they're "wrong" or they "need additional information from the provider".

I called Cigna eleven days ago, asking about the status of the 2013 claims. It had been over 6 weeks since those claims were received at Cigna. I learned that they'd just shoved the 2013 claims in some "dungeon" for dead, null claims. Why did they do that? One of the CPT codes on the claim, written by my provider, was missing the last digit! Instead of notifying me or the health care professional, though, Cigna just put the claims in a claim "graveyard" and had no intention of telling either one us that one of the codes was short a number. That would have been an easy fix. BUT, that scenario would require that Cigna employees would have to DO THEIR JOB. And Cigna would have to PAY those 2013 claims. That's something they don't want, so instead they chose to pretend that the 2013 claims didn't exist. Out of sight, out of mind! Great business practices, Cigna!

Cigna is a poorly run company whose ignorant employees all tell different stories that contradict one another. A couple of them have "talked a good game" They've said "We WILL see to it that this medical provider DOES send us the proper paperwork with the correct codes on the forms," they say. "We WILL see to it that she does the right thing so that you'll get reimbursement for co-pays" (that I needlessly shelled out for 3 years). "We WILL advocate for you!" Right. When? They've been saying that since SEPTEMBER!

They promised to call the medical provider's office about the botched claims and then call me back with an update. I never got a follow-up call. It's been ELEVEN days since I was promised that call. It's been ELEVEN days since I spent NINETY minutes on the phone with a Cigna rep who feigned helpfulness. Yet she, like all the others, just dropped the ball and forgot about me.

The employee I spoke with on 11/12/13 - for 90 MINUTES - promised to call my medical provider's office manager to "coach" her through filling out the 2013 claims with the correct CPT codes and diagnosis codes. (This is something she - a medical office manager! - SHOULD know how to do). That same day, after NO promised follow-up Cigna call, the medical provider's officer manager called me and told ME to call Cigna and give them the conversions of the "old" pre-2013 CPT codes into the new 2013 codes! (I'd found the conversions online with a search). It's not MY JOB to provide code conversions to my insurance company. It is THEIR JOB to know the codes and it's the medical provider's office manager's JOB to file the claims CORRECTLY and to be in touch with the insurance company! I'm not going to call Cigna and say, "Change the code on that claim from ABC to XYZ." I'm not the medical provider! It's not within my authority to do that! The OFFICE MANAGER should be doing that! But again, that would require her to actually DO HER JOB!

I have done SO MUCH of the legwork here: phone calls upon phone calls, wasting pre-paid, limited cell phone minutes, printing 185 pages of claims, running out of printer ink and running to go buy more, spending almost $15 mailing those claims, calling again, and seeing - seven or eight WEEKS after they received the packet I mailed - that the 2013 claims don't even exist on the web site as "pending", (like the older claims say).

So then I had to call again regarding the whereabouts of the 2013 claims they received two months ago. Then I'm just told that Cigna "never received any claims from 2013". After I yelled, "YES YOU DID! You signed for them on 10/2/13,", the Cigna employee magically "found" the 2013 claims - with the one-number-off CPT code - in the "claims graveyard" where they were tucked away so they wouldn't have to pay them. Supposedly the Cigna rep (or so she SAYS) has NOW resubmitted them to the "claims department". That was ELEVEN DAYS AGO. So now I can wait another 2 months before they're returned to me with "rejected due to lack of timely filing".

I am at wit's end doing ALL the legwork here. I was the one duped out of $4700 in bogus co-pays. But I'm the one calling, checking the website, asking questions, taking notes, calling again, being on hold and disconnected, and being assured by my own medical provider that she'll "make sure it's done correctly", as she carelessly omits the last digit of the CPT code! Then she lets her secretary ignore my claims which were sent back by Cigna due to lack of info. (The provider filled them out wrong). The secretary just tossed the claims aside for DAYS. Why? Because she "didn't know the old, pre-2013 CPT codes" (That was her excuse to me). So she wasn't going to ASK or look them up online to find the easy conversion chart (as I did)? How about she CALL Cigna to find out the correct way to fill them out? There's a novel idea! She was just going to let the paperwork sit there and grow cobwebs?

Nobody wants a resolution. They don't care because they would have to do some work that doesn't directly benefit them. They don't care about the injustice. The medical provider already got her money from me. Cigna wants me to go away so they never have to pay out on my claims. So it's only me - alone - fighting by myself, trying to recoup money I never knew I wasn't supposed to pay!

The Cigna forms all say, "Your in-network provider should be filing your claims for you." What a joke. I'm doing everything MYSELF, talking to 9-10 different Cigna employees who all tell me different things while condescending/placating because they want me to just go away.

I want the $4650+ that I am owed, out of which I was duped as I spent it needlessly in that office! This uphill battle is now affecting my health negatively!

I know this isn't about disability, per se. But the reason I lost my Anthem coverage was because I had to take early retirement disability. I get a small stipend from the state. I used to have a good-paying job, but I am disabled and I had to apply (and "prove" my disability) in order to be approved for a retirement disability allowance. I'll be eligible to "fully retire" - and collect a pension - in 20 years. So, for 20 years, I live off of a disability allowance. That's how I lost my Anthem coverage - by retiring. Now I have only Cigna through my husband. But they are useless over there at Cigna, and this "fight" is truly having a negative physical effect on me. Can anyone help me in any way? Thank you.


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