Complaint / review text:
On March 12,2015, I had dental procedures performed. A dental claim was filed by the dentist on that date. Prior to the procedure, a predetermination was submitted to Cigna with all information regarding past procedures relating to the current procedures, such as previous extractions and previous appliances and all information regarding current procedures. The predetermination was approved and I was sent a copy showing what Cigna would pay for each procedure. Since March 12,2015, Cigna has on more than one occasion contacted the dentist for more information (which he had already sent them, but he provided it again).
In June of 2015, I began contacting Cigna (and of course, spoke with a different rep each time and had to explain each time all that had transpired) and their response, from each rep that I spoke with was that they needed more information and when I stated, "I just gave it to you" their response was "oh yes, I see that here now and I will get with processing and see what is going on." I would then request that they call me and let me know what processing has to say (Oh, I forgot, they always told me when I requested, that I could not speak with processing).
Of course, I never received a call back from them. Today I went into my Cigna account to check on the claim and there was a "new" "Dental Claim Detail" showing a new claim number with the claim received date of 7-10-15 and a claim processed date of 7-10-15. I immediately contacted my dentist and verified that they had not sent in a new claim. Wow - I have copies of three different "dental claim detail" forms with each showing a different claim numbers and different received and processed dates.
A dentist expects to be paid within 90 days. Cigna states they have 30 to 45 days to process and pay, which is reasonable, but what is going on with Cigna when they take an extreme excess amount of time to pay? Is it incompetent employees? Is it poor management? Is it that they cannot afford to pay claims? Is it they just do not care about their enrollees and just do not pay? Whatever it is, it definitely needs to be corrected.
The correction process begins with our State Insurance Commissions (this office may be called by different names in different states, but each state has an office that regulates insurance companies). Each individual that has problems should keep copies of everything, document the date, time, name of person and what was said on each contact and file a complaint with your state insurance regulation office. I urge each individual who may have a 'legitimate' problem with any insurance company to document, document, document, and file a complaint with your state insurance regulator. Phone numbers for these offices can be obtained by phoning the state information number in your local phone directory and requesting this number. The regulatory office will provide you with guidelines and instructions.