Cigna HealthSpring Dysfunction, a real mess

I am amazed at how dysfunctional some companies are and how little we citizens can do about it. Cigna comes to mind. In December Cigna HealthSpring was the only Medicare Advantage plan in Arizona that the Center for Medicare and Medicaid Services (CMS) ranked with five stars, the highest rating possible. In fact, it was one of only a handful of plans in the whole country to receive that high rating.

Then, on January 21 of this year, a few weeks after the window had closed for seniors to change their Medicare Advantage Plan, CMS sent an open letter to Cigna HealthSpring suspending its right to enroll Medicare beneficiaries, due to “widespread and systemic failures” of Cigna to provide provide proper services. CMS had given the Cigna plan five stars even though “Cigna has had a longstanding history of non-compliance with CMS requirements.” The letter to Cigna goes on to say, “Cigna has received numerous notice of non-compliance, warning letters, and corrective action plans from CMS over the past several years.” Even though CMS repeatedly pointed out the same problems to Cigna over a period of years, Cigna did not correct them, and CMS gave at least one of the company’s dysfunctional plans five stars. Go figure!

You can read the CMS letter to Cigna by clicking here.

I am covered by Cigna HealthSpring. Why did CMS lead me and other Medicare recipients to believe that Cigna was a five-star provider when in fact CMS knew that Cigna’s problems were so grave that it CMS had years ago judged the company unfit to insure Medicare patients? Why was this information withheld until after the time had passed for us to change to another plan? In other words, why did CMS, a federal government agency, lie to us?

I am personally having problems with Cigna HealthSpring. I have not been able to obtain my coverage card for 2016, apparently due to an unresolved computer problem. On multiple occasions a customer service representative has typed a request into a computer terminal that I be sent a card, but the computer doesn’t send it. When I tried to resolve the problem higher up within the company, the response I get was that “I spoke to a Healthsprings customer service advocate who confirmed that they have sent out multiple cards and they are being mailed to the address on file.” What is meant, of course, is that customer service has made multiple requests to send a card. A troubleshooter checked and told me that no card has been sent  and that my “address of file” is correct. No one fixes the computer problem. The request was typed into the computer, so everything is OK.

I shouldn’t complain too loudly about my situation. From what I have been reading, there have been multiple instances of people being denied coverage by Cigna for life-threatening situations. Again it appears that the main culprit is the company’s dysfunctional computer systems and the lack of will to fix them. I hope no one has died due to Cigna’s dysfunction.

Other large companies have a single website that customers can log onto. Cigna has multiple websites and apparently multiple computer systems that don’t talk to each other. It’s information technology is a jumble of poorly-maintained computers. Want to check on your drug claims? Go to site X. Want to check on your medical claims? Err… well, we’re working on that. It worked last year, and we’ll get it working again someday. How about checking your medical records? That’s another website, which in my case is the only one that works.

The Cigna mess pales, of course, in comparison with the situation in Flint, Michigan where children may have suffered irreparable brain damage due to the city’s lead water pipes. I have not heard of any plan to replace the pipes. That is an even more drastic example of where government oversight has failed. People may have shortened lifespans due to bureaucratic incompetence.

Some people, so disgusted with government’s bureaucratic failure, think it will be solved if they vote for the most-outrageous presidential candidate. It won’t be.