Obsolete Phone Number Costly to Cigna
The toll-free number 877-562-0975 is non-functional. Call it and you'll be connected to a computerized voice asking for a PIN. It had once been a pager number, but its carrier dropped support of the number years ago as communications morphed from pagers to cellphones.
But as late as 2011, it was the number Cigna California provided to the Department of Managed Health Care to lodge after-hours appeals regarding delivery of care issues – appeals that apparently couldn’t reach the insurer, an administrative law judge recently concluded.
As a result, she ruled Cigna should pay a $150,000 fine levied by the DMHC for failing to provide a representative to settle urgent grievances.
The penalty arose from a January 2011 incident when a Cigna enrollee with a 12-year-old daughter was trying to determine the status of an appeal of her pending discharge from a rehabilitation hospital. The child suffers from cerebral palsy, mental retardation and renal disease, and had been hospitalized after suffering an hours-long seizure and a lengthy coma. She was set to be sent home without provisions for renal care, physical therapy or a visiting nurse. Her mother eventually contacted the DMHC.
An agency employee attempted to leave a contact number via that line four times, but was never called back.
It had turned out that Cigna had received the appeal and had decided to extend the patient's hospitalization for several more days, but never contacted her mother. Only after pressing her case did the DMHC employee, a nurse by training, received that information from Cigna.
The insurer quickly replaced the pager number – which records show it had employed since 2003 or 2004 –with one that connected to a cellphone with texting capability.
The DMHC levied the penalty in November 2011. However, Cigna appealed the decision, which was heard by an administrative law judge in Los Angeles in September 2012.
Although neither Cigna nor the DMHC could confirm just how long the number was not properly functioning, the insurer argued to the judge that the violation was relatively minor and that it should pay only a $5,000 fine.
That sum represented a $2,500 daily penalty for the two days it was definitively known by all parties to be out of commission.
In her 12-page decision, Administrative Law Judge Erlinda Shrenger rejected that argument and concluded that having a non-functioning number for after-hours appeals was a serious violation.
“Not having the necessary system in place to respond to urgent grievances – could have put at risk the life of a seriously disabled 12-year-old girl,” she wrote. “It is simply good fortune that it did not cause actual harm - other than the likely anxiety of the enrollee's mother and the waste of (the DMHC employee's) time and state resources – or endanger the life of any other Cigna enrollee.”
Shrenger also ruled that Cigna California, with more than $72 million in liquid assets on hand, had the means to pay the fine, whose amount she noted was intended to serve as a warning to other insurers.
The fine, which was disclosed by the DMHC late last month, is the third largest of the more than 100 penalties it has issued this year.
A DMHC spokesperson did not respond to a request seeking comment about the Cigna case.
