Cigna-Healthspring Appeal Case Study

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Thank you for your follow-up related to this Fast Appeal for Mrs. Letha Washington. You have been very instrumental in ensuring that Mrs. Washington got the necessary medical referrals while here in Houston, TX and we truly thank you for all you have done in that area. This letter is a direct rebuttal to your Grievance Resolution letter dated 2/5/16: 1. In your letter on page 2 you stated “ Per the Centers for Medicare and Medicaid Services (CMS) guidelines, Cigna-HealthSpring is required to mail a letter acknowledging receipt and processing of a Customer’s enrollment application.” a. Let me be very clear the letter from American Benefit Services (ABS) Mrs. Chris Drury - Medicare Benefit Specialist whom is an agent for Cigna-HealthSpring dated 9/29/15 states “ It was a pleasure working with you and I am very pleased to be able to help you continue your coverage with Cigna-HealthSpring.” “Just a reminder, the doctor we chose for you was Dr. Michael Buxbaum at 1214 Hermann Dr, Ste 230, Houston, TX 77004”. b. Clearly this acknowledgement letter informs us that we have secured Cigna- HealthSpring coverage in Houston, TX. Please find attached the full letter from ABS your agent. i. Once we received confirmation of coverage we started the process of moving Mrs. Washington to Houston, TX. As we …show more content…

Goodson, we are certain that Mrs. Letha Washington has been negatively impacted due to negligence on behalf of Cigna-HealthSpring and its agents. Mrs. Washington would not have incurred the expenses to move to Houston, TX if she did not have confirmation of insurance coverage. We are requesting that a special enrollment be made for Mrs. Washington to allow her coverage in the Cigna- HealthSpring Texas with ESRD. We will also be contacting CMS to explain to them that we feel we have been negatively impacted due to your sanctions on 1/22/16, we will be requesting a special enrollment and waiver of the ESRD so that she may enroll in the Cigna-HealthSpring of

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