问HN:有哪些最佳资源可以帮助应对健康保险拒赔?
在2023年底,我在美国以外的地方产生了医院费用,自费大约花费了3000美元。我向Cigna提交了索赔,尽管我收到了提交的电子邮件确认,但直到2024年(当时我的雇主Zoox介入后),我才在Cigna的仪表板上看到这些索赔。
Zoox最初在促使Cigna回应索赔方面提供了帮助,他们告知我Cigna需要哪些额外信息。Cigna给出的拒绝理由不一致,包括声称由于我的计划“由不同部门处理”,我需要重新提交,以及“供应商故障……导致我的许多索赔未能通过”。我至少有两次通过聊天与Cigna沟通,但每次在代理要求更多时间后,聊天都中断了。
与Cigna的对话记录: https://docs.google.com/document/d/1dNDsCJ0_LSed4CmCmkSPQYMA-MpDPL6vg9lVRR1rgOY/edit?usp=sharing
最终,Zoox也停止了回应,尽管我通过电子邮件跟进了几次。
有没有办法让Cigna对我的索赔进行诚信审查?有没有政府机构可以帮助我,或者外部公司可以协助我进行上诉?
查看原文
In late 2023, I had hospital expenses outside of the USA, and spent about $3k out of pocket. I submitted the claims to Cigna, but even though I got email confirmations of my submission, it was only until 2024 (when Zoox, the employer who the insurance was through, got involved) that I could see the claims in my Cigna dashboard.<p>Zoox was initially helpful in getting Cigna to respond to the claims, and they let me know what additional information Cigna needed. Cigna gave inconsistent reasons for why my claims were rejected, including saying that I needed to resubmit due to my plan being 'handled by different department', and that a 'vendor outage... prevented many of [my] claims to come through’. There have also been at least two times that I have talked with Cigna over chat, only to have the chat die after the agent asks for more and more time.<p>Conversations with Cigna: https://docs.google.com/document/d/1dNDsCJ0_LSed4CmCmkSPQYMA-MpDPL6vg9lVRR1rgOY/edit?usp=sharing<p>Eventually, Zoox stopped responding as well, though I have a followed up a few times through email.<p>Is there any way to get Cigna to have a good faith review of my claims? Any government agencies that can help me, or outside companies that can help with the appeal?