I have this health insurance through my job, but pay all the premiums myself on a pretax basis. There is no other offering via the job. Their sales pitch is great...the follow through criminally bad. Over and over again, they are just plain refused to cover even the most minimal things they are contractually obligated to cover, requiring me to make a multitude of calls to both medical providers and the insurance company. Of note is that I have a healthy family, and we have filed very few claims, all for preventative services that are routine.
This is my first, and hopefully last year of experience with Cigna:
The HSA.... their investment options are very insufficient, and difficult to navigate.
Their website registration process did not work, because they put in the wrong SS number for me.... and it took months to straighten that out, and at least ten phone calls and several letters to fix that issue. (They had no issues understanding how to take my monthly payments however... but even on the phone they could not verify that I had coverage for several months.
Twice now they have not been able arrange any flu shot costs to be accepted by any pharmacy.... although it is covered by the policy... for unknown reasons.
The real kicker was the preventative care/mammography services my spouse had recently... which are required to be covered by the new insurance laws with no deductible/copay. Cigna was blatantly in violation of the law in refusing to pay this bill, presumably hoping we would get worn down and pay it ourselves, out of ignorance of what the policy covers, and what the law requires them to cover.
Cigna repeatedly has refused to pay for a spouse's mammograms, which in fact they are by law now required to cover in full. I spoke with them perhaps six or seven times in regards to this one event. Each time I speak with a minimum wage type employee who has no knowledge or insight to what my insurance covers or does not cover, and that person reads from a menu of standard refusal to pay scripts... citing things like "it was not preapproved"... which is by no for that procedure not required, then they changed their mind to "it was coded wrong" (by the billing persons for the medical providers)... which is in fact not the case at all. That said, I asked them to tell me which code was incorrect, and why they felt is was incorrectly coded... and the answer was "we do not discuss that because that would be a HPPA violation"... also not true... but I then offered the spouse(patient of discussion) to them directly on the phone to give that info to... and again they refused, citing HPPA violation rules. This is both incorrect and blatantly dishonest. Considering that the person on the phone was simply following a menu designed to give no resolutions, and no real information... I then asked that this call be accelerated up the line of decision makers with more authority. This was said to not be possible, and my request for a reason for denial of this reasonable request was not forthcoming. The bottom line here is: They appear to be interested in inducing enough frustration in the sucker who bought the policy to make them give up altogether and simply pay the bill themselves.
After about 15 phone calls to both the hospital billing/accounting offices (who were very helpful and very honest...) and Cigna... (who did everything possible to blackball the payments that were due, I told them in no uncertain terms that this issue will be settled during this one last phone call or I will seek other measures of resolution as itemized below.
1. I reminded them that their actions are illegal violations of new national insurance laws, and in violation of their contract with our business group and the insurance laws of the State of Washington. I offered one last chance to tell me when the bills will be properly paid, and to send me written explanations and responses to my concerns, written by someone in a position of authority.
2. Told them that the following steps would be taken if this last phone call did not result in them fulfilling their obligations to my family and the health care providers:
a. A full written itemization of their illegal activities and violations of their contract would be reported to the insurance commissioner's office of the state of Washington.
b. A copy of this report would be sent to my national and state senators and congress persons, our business group members and employees, Several national newpapers, my local newspapers, the insurance office who aggressively sold the policy with false claims, and our local television consumer advocate news station.
Guess what.... at that point, after hours of work in trying to sort out if there was a legitimate reason for their refusal to pay those healthcare bills and finding no such legitimacy, They agreed to pay the bill as they should. Should they not have simply paid the bill from the start. YES.
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