Complaint Review: CIGNA - Nationwide
- CIGNA Nationwide USA
- Phone: 800-244-6224
- Web: Www.cigna.com
- Category: Health Insurance
CIGNA Cigna HealthcareCIGNA Insurance Potential life threatening condition corrective procedure coverage denied Nationwide Nationwide
*Author of original report: Appeal Filed Denied, Second Appeal Filed
*Consumer Comment: If this procedure IS covered by your WRITTEN policy and they're denying it illegally...
*Consumer Comment: Appeal it
*General Comment: you can appeal
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We are currently FIGHTING with CIGNA regarding coverage for a MUCH needed procedure for my wife, who suffers from Venous Insufficiency.The doctor called and advised of the procedural "CODES" they would be using and were informed that they would not pay for the procedure because it included within the description "Varicose".
They said they do not cover "COSMETIC" type of surgeries due to being "ELECTIVE" and not REQUIRED. My wife had a DVT (Deep Vein Thrombosis) prior to this and the need for this surgery is essential for her to maintain good health.
In short the denial could be considered "LIFE THREATENING". But the insurance company arbitrarily denies claims based on a "DATA SET" and not what is really needed to take care of their policy holders. I was on the phone for over an hour just to find out they (CIGNA) would not even discuss this with me, FLAT OUT REFUSED TO TALK TO ME, did not give any directions, processes, or procedures to file an appeal, just "I'm sorry sir this procedure is not covered by your policy" (REPEATEDLY).
When asked to talk to the "Person who could do something" they also refused to allow me to even to talk to "THAT" person.
If you ask me it's "BAD FAITH" all the way.REMEMBER the "DVT"** THIS IS, IN MY WIFE'S CASE POTENTIALLY LIFE THREATENING!!!
An employee of CIGNA actually attempted to incite FRAUD and directed my wife's doctor to use another medical code to try to get this covered. the only applicable code is the one they are trying to deny our claim.
The doctor had already obtained authorization from CIGNA (on 2 separate occasions)surgery scheduled, but the day, mind you THE DAY BEFORE the scheduled procedure, adevised the doctor there was no coverage for this procedure. incompetence, uncaring people within the CIGNA CORPORATE CULTURE!!
This report was posted on Ripoff Report on 05/20/2014 05:54 PM and is a permanent record located here: https://www.ripoffreport.com/reports/cigna/nationwide/cigna-cigna-healthcarecigna-insurance-potential-life-threatening-condition-corrective-pr-1148377. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content
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#4 Consumer Comment
Appeal it
AUTHOR: Stacey - ()
SUBMITTED: Thursday, June 19, 2014
This is in no way "cosmetic surgery". This is just what you stated. I suggest you see a Vascular Surgeon if this Dr is not one. If this Dr is, then APPEAL!
#3 Author of original report
Appeal Filed Denied, Second Appeal Filed
AUTHOR: Mark - ()
SUBMITTED: Thursday, June 19, 2014
Appeal Denied, just like the original.
- CIGNA DID NOT FULLY INVESTIGATE THIS CLAIM,
- CIGNA HAS DENIED ALL ATTEMPTS TO OBTAIN A PEER TO PEER with My Wife's doctor.
- CIGNA has denied this claim SOLELY on the basis of of Procedure codes, not on the fact this procedure is needed (Medically) to maintain her good health (Something CIGNA states they are "ALL ABOUT KEEPING THEIR INSURED"S HEALTHY") and have a good quality of life.
- CIGNA Representatives have on numerous occasions encourage perpertrating a FRAUD by stating that the doctor should just use a different billing code.
Here is what insurance companies SHOULD DO. "When in doubt, Pay the claim". don't use data driven information to make a determination regarding someone's life, quality of life and longevity, making life decisions for someone else is just morally WRONG.
Insurnace companies (That is what CIGNA IS) HAVE A DUTY, thats right a DUTY!!!! An insurance company has a duty to fully investigate an insured's claim for benefits before denying it. (NOT COMPLETED, DENYING A PEER TO PEER REVIEW) A thorough investigation and fair evaluation of an insured's claim requires an insurance company to all supporting documents (PROVIDED BY my wife's DOCTOR). Further, the insurance company cannot ignore evidence that is available to it which supports the claim. That is, the insurance company cannot focus only on the facts that would justify its denial of the claim(EXACTLY WHAT CIGNA IS DOING).
Under the law of most jurisdictions in the United States, insurance companies owe a duty of good faith and fair dealing to the persons they insure. This duty is often referred to as the “implied covenant of good faith and fair dealing” which automatically exists by operation of law.
#2 General Comment
you can appeal
AUTHOR: Fred - ()
SUBMITTED: Wednesday, June 18, 2014
you can appeal the decision. go into your mycigna.com account and go to forms there is a form there that you can use to submit an appeal. make sure that you have all notes from dr and confirmation that he talked to a Cigna doctor and when he did that.
good luck
#1 Consumer Comment
If this procedure IS covered by your WRITTEN policy and they're denying it illegally...
AUTHOR: Ken - ()
SUBMITTED: Tuesday, May 20, 2014
Notify your states insurance commissioner. If you are just hoping they will somehow cover it anyway, don't know what to tell you. There are many levels of coverage with insurance. Have you read your policy?
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