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Cigna DentalWaiting Period Misunderstanding

I would first and foremost like to say that I do take some of the responsibility in what transpired between myself and Cigna Dental. It has taken me several months to have time to write this review, and we still are Cigna customers for the simple fact that it wouldn't make since for us to drop them YET. My husband and our family became cigna customers at the end of 2012 through his work. In January of 2014, his company was suddenly bought out by another company who's benefits did not compare, and actually qualified us to use the Healthcare Marketplace. After the disaster of trying to get enrolled, we finally got Cigna Dental again that started on April 1st. Let me say, that even though we paid for our Dental Benefits for over a year with his old company, we never even filed a claim because my husband hates doctors and I have near perfect oral health. Moving on... I finally talk my husband into visiting dentist because I KNOW he has procedures that he needs done. They made my husband a care plan that was lengthy and expensive. They showed us what we would be responsible for and what my insurance would pay, and how the dentist got those numbers except from the insurance is beyond my knowledge.However, it showed the insurance company paying all but 20% of the cost. The receptionist asked if we had a waiting period, and I said that I did not know. She told me that she would call and find out for me, and I said I would look into it as well. I logged onto my cigna account, and I could find my deductible, coverage limits, definitions.. everything EXCEPT any information about a waiting period on my policy. (BTW I went back and took screenshots of every webpage of their website related to my policy). I also went back to look at the original packet they sent me. The only thing it had in it was basic definitions, and directives to visit the website, which I also still have. I called and asked for my benefits booklet because obviously that couldn't be it with so little information (which is actually pretty much how the 2015 booklet is too) . In the next week, I received the same booklet that I already had. So I had found no information about my specific waiting period yet. In the next couple of days, the receptionist calls us and tell me that "she spoke to somone, but he was hard to understand because he was a foreigner". She said that he told her we only had a 12 month waiting period on major. So we scheduled my husband's fillings, and paid our 20% that same day to the dentist. In the next couple of weeks, our receptionist called to tell us the unfortunate news that they did not cover his fillings because of an apparent basic waiting period. I called Cigna, and tried to talk to a representative. I asked her why they had waiting periods, and she said so that people would not sign up, get major work done and then stop paying their bills, which is understandable. (I also recorded these conversations). I then told her what had happened, and offered to pay the policy in full if they would pay the claim. She said that was impossible. I then made the point that we were technically not new customers, and she went back and looked, and told me that they considered us a new customer because it had been more than a 60 day lapse in coverage. I went back and counted, and our lapse (which was a little beyond our control) was 67 days. My husband did not develop cavities in 7 days, and we would have waited the 2 months to go to the dentist if we had known there was a waiting period for basic. I then mentioned the call, which she said they only used for training and couldn't pull back up, which is BULL. I worked for a very reputable P&C insurance company, and EVERY call was recorded and could be pulled up if needed. She even went as far as too say that there were no notes made of a call in my file. I then asked if there had bene anyone in my account on ( specific date), and then she finally said "Oh yeah it looks like a Rebecca called in to verify benefits, but the call was dropped." Sure, since you already lied. I then asked to speak to a manager, and she absolutely did not want me to. She tried to say no one could do anything for me and that a manager would tell me the same thing. It was almost as if she thought that claim money was coming directly out of her pocket. They manager however was very helpful and gave me the resources to file and appeal. I filed two appeals, basically making all the points I have made here and then some. The second appeal I specifically asked what was said between their representative and the receptionist, because if the receptionist had lied, I wanted to know. The last appeal denial which came from a Sandy H., said "Please be advised that verifying benefits verbally is not a guarantee of benefits." This leads me to believe that the receptionist was in fact telling the truth, and it alsos brings about the question of how do we trust a company as a whole, when they are basically saying you can't trust our representatives? Also, why was it so hard for me to find any information about a waiting period? Is it because they are kind of tricking people into paying for some of their procedures out of pocket before their benefits kick in? So to sum it up my husband had to pay in total over $500 out of pocket for fillings that could have waited another 2 months, and we will be leaving the company for good, but only after he finishes getting all of his work done. They are losing a potential life long customer (we are in our mid 20s) over a paying a claim that is decimals to them.

Cb
Feb 05, 2015

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