Provider is Cigna PPO LocalPlus through my husband’s employer.
Deductible is $1750, Out of Pocket Maximum is $4500.
Main question in bold at the bottom.
I had my baby in late December 2021 (21st to 23rd… 53 hrs of labor, RIP). When I got my bills from the hospital in January, they seemed too high. I was assured multiple times by chat agents/phone agents at Cigna that the most I could possibly owe for covered services (in network) in 2021 was $4500, but my patient responsibility for all of 2021 is totaled at more than $6000. Note that nearly everything for 2021 for me was for covered services and in network. (If it wasn’t, it didn’t go through insurance at all.)
I contacted Cigna on Feb 10th 2022 to ask about this. The chat agent I spoke to explained some of my claims had been incorrectly attributed to my 2022 deductible, even though all services were in 2021 and should apply only to my 2021 in network deductible/out of pocket maximum. This has resulted in Cigna reporting an incorrect amount for Patient Responsibility to my providers. They told me they would escalate the matter for review and I should see a correction in “7 to 10 business days.”
Since then, they’ve called me every Friday to tell me they haven’t finished reviewing it, they’ll send another email to the review team, and to expect a call in 7 to 10 business days. In the meantime, the hospital and birthing center are expecting payments and things are going overdue. It’s been over 30 days now. I’m keeping the providers informed on Cigna’s delay, but don’t know how long that’s going to work.
Is there a legal limit to how long Cigna can kick this can down the road before they must correct the claims so I can pay my bills in a timely manner? What do I need to look into, or what regulatory agency do I need to contact, to put a fire under their butts and get this corrected?
Thanks for any help at all!
submitted by /u/MoonBapple
[link] [comments]Provider is Cigna PPO LocalPlus through my husband’s employer. Deductible is $1750, Out of Pocket Maximum is $4500. Main question in bold at the bottom. I had my baby in late December 2021 (21st to 23rd… 53 hrs of labor, RIP). When I got my bills from the hospital in January, they seemed too high. I was assured multiple times by chat agents/phone agents at Cigna that the most I could possibly owe for covered services (in network) in 2021 was $4500, but my patient responsibility for all of 2021 is totaled at more than $6000. Note that nearly everything for 2021 for me was for covered services and in network. (If it wasn’t, it didn’t go through insurance at all.) I contacted Cigna on Feb 10th 2022 to ask about this. The chat agent I spoke to explained some of my claims had been incorrectly attributed to my 2022 deductible, even though all services were in 2021 and should apply only to my 2021 in network deductible/out of pocket maximum. This has resulted in Cigna reporting an incorrect amount for Patient Responsibility to my providers. They told me they would escalate the matter for review and I should see a correction in “7 to 10 business days.” Since then, they’ve called me every Friday to tell me they haven’t finished reviewing it, they’ll send another email to the review team, and to expect a call in 7 to 10 business days. In the meantime, the hospital and birthing center are expecting payments and things are going overdue. It’s been over 30 days now. I’m keeping the providers informed on Cigna’s delay, but don’t know how long that’s going to work. Is there a legal limit to how long Cigna can kick this can down the road before they must correct the claims so I can pay my bills in a timely manner? What do I need to look into, or what regulatory agency do I need to contact, to put a fire under their butts and get this corrected? Thanks for any help at all! submitted by /u/MoonBapple [link] [comments]Read Morer/HealthInsurance