CIGNA HS Has Been Sanctioned by CMS

Does anyone know why Cigna Healthspring was sanctioned? The are a very small portion of my business.

If you read the link TN_Agent posted, it says:

"CMS imposed sanctions due to deficiencies discovered with Cigna's operations of its Parts C and D appeals and grievances, Part D formulary and benefit administration, and compliance program"
 
Got a email today from CIGNA HS...

"Please note that marketing and enrollment activities for Cigna-HealthSpring’s Medicare Advantage and standalone prescription drug plans have been suspended until further notice due to CMS sanctions. As a result, you must cease marketing to and contacting potential enrollees on behalf of Cigna-HealthSpring. The suspension does not impact current Cigna-HealthSpring Medicare Advantage and Medicare Part D enrollees’ benefits or plans.

We appreciate your prompt attention to this matter. We remain committed to our ongoing partnership and will keep you informed of developments as we work with CMS to return to active enrollment.

Cigna-HealthSpring"

OMG. CHS really SUCKS BIG TIME in my San Antonio market, but is HUGE in Houston, El Paso and the south Texas Rio Grande Valley.
 
Cigna suspending the enrollment of new customers in their Medicare Advantage and stand-alone Prescription Drug Plans.

For the time being, agents must cease marketing to and contracting potential enrollees on behalf of Cigna-HealthSpring. Current enrollees in Cigna MA or PDP plans will not be affected.

Based on prior cases, CMS sanctions can last around 9 to 15 months. There will certainly be more information to come.

CMS brought down the penalties following the discovery of issues with Cigna’s appeals and grievances, formulary and benefit administration, and compliance programs. The company’s stock slid 3 percent in premarket trade Friday after climbing 8.2 percent over the past three months.
 
Healthspring of IL was a really good plan for a long time then Cigna bought them out in 2012. They had been scrambling during CMS call center audits when I sat in as an independent, we actually did really well in 2014 audit. Then they cut us out of the CC and moved operations to Houston in Aug. 2014, big mistake since they didn't get a local agent except for a handful of captured agents if they wanted a home visit. My wife was grevience director for the last few years until they eliminated her position and severanced her. She was relieved and was on the verge of quitting for the last couple years due to stress she was experiencing. I only enrolled two people this last AEP and they were previous members. I even tried to move them to BCBS. Two beefs I had with their benefits, they dropped silver sneakers for some lesser "silver and fit" benefits and also raised tier 1 and 2 co-
pays when other plans had zero co-pays on tier 1 and even 2. The POS benefit was hard to navigate sometimes. The other thing was when Cigna bought Healthspring they had just merged with Bravo and that created a big customer service mess for Illinois by moving cust. serv. to the Bravo unit. After AEP the Bravo reps in Baltimore were trying to convince my dual eligible clients they didn't need Healthspring and to just go with Bravo PDP. I was like WTF!! Anywho, like someone said, seen it coming!
 
Healthspring of IL was a really good plan for a long time then Cigna bought them out in 2012. They had been scrambling during CMS call center audits when I sat in as an independent, we actually did really well in 2014 audit. Then they cut us out of the CC and moved operations to Houston in Aug. 2014, big mistake since they didn't get a local agent except for a handful of captured agents if they wanted a home visit. My wife was grevience director for the last few years until they eliminated her position and severanced her. She was relieved and was on the verge of quitting for the last couple years due to stress she was experiencing. I only enrolled two people this last AEP and they were previous members. I even tried to move them to BCBS. Two beefs I had with their benefits, they dropped silver sneakers for some lesser "silver and fit" benefits and also raised tier 1 and 2 co-
pays when other plans had zero co-pays on tier 1 and even 2. The POS benefit was hard to navigate sometimes. The other thing was when Cigna bought Healthspring they had just merged with Bravo and that created a big customer service mess for Illinois by moving cust. serv. to the Bravo unit. After AEP the Bravo reps in Baltimore were trying to convince my dual eligible clients they didn't need Healthspring and to just go with Bravo PDP. I was like WTF!! Anywho, like someone said, seen it coming!

Whoa, I didn't know they had "captured agents."

Would hate to be one of those!! :biggrin:
 
I almost, but not quite, saw something like this coming, and I hate it.

Cigna-HealthSpring has been my favorite MA/MAPD carrier for years, and I actually worked there for almost a year and a half in Nashville. They've got a great bunch of people there.

However, I have been getting several complaints from clients who were denied what seemed like pretty basic tests and procedures, or who have had to jump through multiple hoops. One lady who's a neighbor of one of my wife's relatives was refused a walker for a long time, until her doctor wore out the appeals people. A walker! I kid you not. The poor lady can barely walk. My sister-in-law was mad as a hornet because C-HS refused to allow a thyroid-related blood test that her doctor had recommended. She tried to get me to switch her to another carrier last AEP but I talked her out of it.

I hope they get these issues resolved promptly so we can get back to business.
 
Yeah they were so great they got sanctioned by CMS. I feel sorry for your clients.

Let's see, below is a list of SOME of the carriers who have received CMS sanctions:

Aetna
Health Net
UnitedHealthcare of New York
Express Scripts
Health First
Capital Blue Cross
SilverScript
BCBS of North Carolina
BCBS Florida
BCBS Arizona
BCBS Tennessee
Blue Cross of Idaho
Independence Blue Cross
Anthem
WellCare
Coventry
Humana

As I said, that's just SOME of them. Point being, almost no major carrier has avoided sanctions.

But I really appreciate your concern for my clients.
 
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