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David L
David L, Lawyer
Category: Consumer Protection Law
Satisfied Customers: 3255
Experience:  Attorney licensed in multiple jurisdictions.
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We have Cigna insurance. Our plan is Choice Fund OA Plus. The

Resolved Question:

We have Cigna insurance. Our plan is Choice Fund OA Plus. The plan says we don't need a prescription to see a specialist. After seeing a chiropractor, we found out that Cigna has another firm, American Specialty Health, review their claims and this company can deny any claim made. Cigna's plan does not inform subscribers of this. My husband, the policy subscriber, went to speak with his company's benefits rep. This person agreed this was wrong but there is nothing that can be done. I believe my husband did not have the amount of information needed to make an informed choice for our insurance plan. I believe it is wrong that Cigna does not inform subscribers about this other claim review company. What I see is that Cigna sells a plan and then this other company gets to change the rules. And this makes me angry. Did we miss something, or is this legal? I hope you can help us. Sue
Submitted: 5 years ago.
Category: Consumer Protection Law
Expert:  David L replied 5 years ago.

David L :

Hi. This is perfectly legal and in fact, is very common. You will find that most insurance companies now have third-party reviewers. It saves the insurance companies quite a bit of money. Unfortunately, for you and I the insured, it is a big pain having to deal with third-parties. What tends to happen is that more of your claims get denied and it is more work for you to appeal each denied claim. While it is a potential roadblock, the idea is to make sure you appeal any denial until it gets paid.

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