Question
Can Cigna cut off my mom's benefits after 2 years? Also, where can I get their guidelines?
My mom was finally approved for long term disability after 2 denials. On the final appeal, Cigna approved and paid a year’s worth of back pay. After just one month of coverage, they have closed her case stating they never received paperwork, which was absolutely sent in by her and her doctor. Cigna rep later commented that they had all her paperwork and her case was reopened. When she did not receive her check this month, she called and was told that her file was on a “director’s” desk awaiting review. I sat in on a phone call with her and determined that the review is not for medical eligibility but is basically quality control. Some director is ensuring that the determination to reopen is a valid one. It has been over 30 days since they started this review and they state they cannot tell her how long it will take and to call again tomorrow. All the while, she is struggling to make ends meet. They have also told her that because her disability is due to mental illness they will not pay out until she is 65 as she was previously told, but only for 2 years due to some change with the previous employer. So, I have two parts to my question: 1) Can they just cut off her benefits after 2 years? Does she have any appeal rights? 2) Does anyone know where I can Cigna’s guidelines? We have requested this info from them several times and they seem to have no clue what we are talking about. I used to work for an insurance company doing medical authorizations and we were required by law to send out a copy of our guidelines if a patient or doctor’s office requested it. Why is it so hard to get this info from them? Also, WHO does LINA/Cigna answer to? Does ANYONE govern them? They are completely out of control.
Answer
1) A two year limitation of benefits for mental illness is common in Cigna disability policies. It is legal for them to limit benefits to two years if it is contained in the policy language. 2) If you are looking for CIGNA’s claim review guidelines, then you want to look at the a copy of the Summary Plan Description of your Mom’s disability plan. You have the right to submit an appeal if they deny the claim. You can file a complaint with your State Department of Insurance and the Department of Labor. After you exhaust all Appeals, then they can be sued.
