Question regarding rep knowledge

Hello! We have insurance through Cigna Open Access Plus. Two of our dependents have autism so I like to think I’m somewhat versed on what that means is/is not covered under our plan. I’m assuming because of the pandemic, things have been moving a little slower; claims taking longer to process and pre-authorized visits leading to services actually lapsing because Cigna isn’t sharing the information as the used to with the service provider (several times I’ve received the paper authorization in the mail before they have electronically this year). So, I was contacted Cigna 5 times total yesterday. 3x via chat, 2x on the phone. I was trying to find out why our service authorizations had lapsed. The first 4x I was told that we were capped at 20 visits even though we’ve had well over that this year. I explain the autism diagnosis waives the cap for these types of services. I am repeatedly told, no, this is wrong, that’s your plan. Okay. So I try to pull up our actual plan. I’ve looked through it before a couple years prior. It’s no longer on Cigna’s portal. There’s a brief summary but it is not all-inclusive. We’re actually on COBRA rn so we don’t have easy access to the plan’s administrator though my guess is it would be HR of the company the plan is associated with. It turns out this is unnecessary and by the time I speak to person #5 she tells me the letter is on its way. Terrific. But this leads me to my question (I apologize for being long-winded); why are insurance representatives allowed to pass off bad info? At what point is it a real liability? I’m fortunate that I’ve been down this path, but I know a few years ago I would’ve just accepted this and thought oh well. Is there any recourse? I don’t want to get anyone fired, but this is such a blatant stressor for me and probably other people and it’s so out of hand.

Edit: We’re in TX, FYI

submitted by /u/lhiver
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Hello! We have insurance through Cigna Open Access Plus. Two of our dependents have autism so I like to think I’m somewhat versed on what that means is/is not covered under our plan. I’m assuming because of the pandemic, things have been moving a little slower; claims taking longer to process and pre-authorized visits leading to services actually lapsing because Cigna isn’t sharing the information as the used to with the service provider (several times I’ve received the paper authorization in the mail before they have electronically this year). So, I was contacted Cigna 5 times total yesterday. 3x via chat, 2x on the phone. I was trying to find out why our service authorizations had lapsed. The first 4x I was told that we were capped at 20 visits even though we’ve had well over that this year. I explain the autism diagnosis waives the cap for these types of services. I am repeatedly told, no, this is wrong, that’s your plan. Okay. So I try to pull up our actual plan. I’ve looked through it before a couple years prior. It’s no longer on Cigna’s portal. There’s a brief summary but it is not all-inclusive. We’re actually on COBRA rn so we don’t have easy access to the plan’s administrator though my guess is it would be HR of the company the plan is associated with. It turns out this is unnecessary and by the time I speak to person #5 she tells me the letter is on its way. Terrific. But this leads me to my question (I apologize for being long-winded); why are insurance representatives allowed to pass off bad info? At what point is it a real liability? I’m fortunate that I’ve been down this path, but I know a few years ago I would’ve just accepted this and thought oh well. Is there any recourse? I don’t want to get anyone fired, but this is such a blatant stressor for me and probably other people and it’s so out of hand. Edit: We’re in TX, FYI
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