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    JimCoburn's Avatar
    JimCoburn Posts: 3, Reputation: 1
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    #1

    Sep 26, 2008, 12:51 PM
    Cigna never paying for almost 3 yr old claim
    Is there a statute of limitations for a health claim in Texas? My son was assaulted outside our home November of 2005 and had some teeth broken and knocked out. The dentists' bills were initially refused because Cigna did not have the dental coverage, just medical, although initially the Cigna rep said that this would be covered as a "medical" claim. I have gotten some money from them but there are other sums in play. I would like to know if by ignoring my claim requests for this long (I fax them additional copies of bills periodically) can they cite some statute for time? And yes, my wife has been rightfully dogging me to get this completed and does not accept my ADD as an excuse anymore!
    JudyKayTee's Avatar
    JudyKayTee Posts: 46,503, Reputation: 4600
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    #2

    Sep 26, 2008, 01:19 PM
    Quote Originally Posted by JimCoburn View Post
    Is there a statute of limitations for a health claim in Texas? My son was assaulted outside our home November of 2005 and had some teeth broken and knocked out. The dentists' bills were initially refused because Cigna did not have the dental coverage, just medical, although initially the Cigna rep said that this would be covered as a "medical" claim. I have gotten some money from them but there are other sums in play. I would like to know if by ignoring my claim requests for this long (I fax them additional copies of bills periodically) can they cite some statute for time? And yes, my wife has been rightfully dogging me to get this completed and does not accept my ADD as an excuse anymore!


    If you didn't have dental insurance I'm surprised beyond surprised that CIGNA paid at all.

    Send them a demand letter and copies of the bills, certified, proof of delivery, and see what happens.

    Is CIGNA claiming against the person who assaulted your son? Are you?
    JimCoburn's Avatar
    JimCoburn Posts: 3, Reputation: 1
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    #3

    Sep 26, 2008, 01:25 PM
    Quote Originally Posted by JudyKayTee View Post
    If you didn't have dental insurance I'm surprised beyond surprised that CIGNA paid at all.

    Send them a demand letter and copies of the bills, certified, proof of delivery, and see what happens.

    Is CIGNA claiming against the person who assaulted your son? Are you?
    My company dental insurance did not pay since they deemed it a medical claim. Cigna only paid the ER room and a small part of the dental work and as I have been shuttled from one person to another they inevitably fall back on the concept that it should be a dental claim. I have obviously procrastinated this but will do as you suggest and send a demand letter.
    JudyKayTee's Avatar
    JudyKayTee Posts: 46,503, Reputation: 4600
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    #4

    Sep 26, 2008, 01:26 PM
    Quote Originally Posted by JimCoburn View Post
    My company dental insurance did not pay since they deemed it a medical claim. Cigna only paid the ER room and a small part of the dental work and as I have been shuttled from one person to another they inevitably fall back on the concept that it should be a dental claim. I have obviously procrastinated this but will do as you suggest and send a demand letter.


    I'm still surprised they paid ANYTHING regarding dental work.

    Please come back and let us know how it plays out.
    Fr_Chuck's Avatar
    Fr_Chuck Posts: 81,301, Reputation: 7692
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    #5

    Sep 26, 2008, 01:27 PM

    Yes, if there was no dental coverage beyond the ER I doubt there will be any payment, have you not received a letter from them dening payment, if so you had a certain amount of time normally under your contract ( policy) to dispute that claim with the insurance company in writing. I am sure that time is long past. You could sue but again I doubt if there was coverage.
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