Health insurance cost containment company

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Topic Author
sng
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Health insurance cost containment company

Post by sng » Fri Jun 14, 2019 9:05 pm

Hi,

Almost 1 year ago, I fell off a bicycle in a national park in Africa and fractured my arm. I had surgery in Africa and subsequent procedure/therapy in the states. My Cigna primary insurance covered my medical claims in Africa and in the states.

Not too long afterwards, I started receiving letter from Accent cost containment company with a long questionaire about my accident in Africa. Accent stated that they are contracted by Cigna to collect the information. Looking at the questionaire, it appears to me to be an effort to figure out if there are other parties who should pay for my medical care. I never responded to the questionaire b/c all my claims were processed appropriately by Cigna.

Recently Accent sent me a couple of letters requesting that I pay back the check issued to me for my medical claim in Africa with reason: paid on incorrect patient/insured. The letters also asked me to call a specific recovery specialist if I have questions.

I am inclined to do nothing b/c my Cigna EOB has not changed and Cigna never changed their processing of my claims. I am thinking that these letters are further attempts to get me to provide information to them.

Has anyone experience something similar before? If yes, how did you handle it? Thanks!

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MP123
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Re: Health insurance cost containment company

Post by MP123 » Fri Jun 14, 2019 9:30 pm

Have you talked to Cigna?

The letter asking about circumstances of your injury is normal so they can figure out if someone else has to pay or if they can subrogate the claim against a party that injured you.

I don't know if it would end up in collections if you just ignore it.

It seems to me that a conversation directly with Cigna would be best.

Topic Author
sng
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Re: Health insurance cost containment company

Post by sng » Fri Jun 14, 2019 9:56 pm

MP123 wrote:
Fri Jun 14, 2019 9:30 pm
Have you talked to Cigna?

The letter asking about circumstances of your injury is normal so they can figure out if someone else has to pay or if they can subrogate the claim against a party that injured you.

I don't know if it would end up in collections if you just ignore it.

It seems to me that a conversation directly with Cigna would be best.
I called Cigna customer service when I received the first letter requesting the refund. (This is the second letter with the same content) The Cigna customer rep just stated that I should contact Accent to find out. She would not comment on the request for refund from Accent. She also stated that there is no change in my EOB/processed claim. She was confident in her reply so it looks like this type of query is not new to her.

I am hesitant to call this company b/c it seems like Cigna did not want to get involved in this.

stlutz
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Re: Health insurance cost containment company

Post by stlutz » Sat Jun 15, 2019 2:50 am

Are you/have you received reimbursement from somebody else who caused the accident? What is the background behind declining to provide the requested information?

HomeStretch
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Re: Health insurance cost containment company

Post by HomeStretch » Sat Jun 15, 2019 7:29 am

As another poster said, this is a normal insurance company request. You should call Accent and provide the requested information.

awval999
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Re: Health insurance cost containment company

Post by awval999 » Sat Jun 15, 2019 8:02 am

You need to fill out the form. It's a normal subrogation form. The insurance company wants to go after someone else to refund them the money that they paid. They only want to pay if you caused the injury yourself.

My wife once dropped a bottle of sparking wine on the driveway, it broke, exploded and gashed her leg and needed stitches, bleeding everywhere, etc. Went to ER, got it fixed up. A month later a similar letter. I filled it out for her and she signed it. It was pretty clear what they were after, one of the questions was along the lines of, "was anyone else the cause of this injury" and I had to write out "[Mrs. awval999] dropped a bottle of sparkling wine on the driveway and it exploded causing injury".

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Watty
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Re: Health insurance cost containment company

Post by Watty » Sat Jun 15, 2019 8:07 am

If you had travel insurance that would have likely paid for a lot of the costs while you were in Africa and Cigna wants to offload any costs that they can to the travel insurance company and make sure that you did not get paid by both companies. Likewise if you were traveling on business(which sounds unlikely) then your company could have had travel insurance that you don't even realize they have.

When you got the letters it was a mistake to ignore them, you should have verified that they were valid and then responded. There is likely something in the health insurance policy that requires you to work with them so not responding to a valid request for information was not an option.

You need to call them and try to get this straightened out. If you did have travel insurance and you just used Cigna because it was easier you may very well need to file the travel insurance claims and pay back Cigna.

Topic Author
sng
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Re: Health insurance cost containment company

Post by sng » Sat Jun 15, 2019 5:24 pm

stlutz wrote:
Sat Jun 15, 2019 2:50 am
Are you/have you received reimbursement from somebody else who caused the accident? What is the background behind declining to provide the requested information?
No, I fell off the bicycle by myself. There is no one else responsible. I did not receive extra reimbursement from anyone else who is responsible. I only received reimbursement from my travel insurance for the medical copay not covered by Cigna. I am reluctant b/c I don't know this company and from searching online it appears there are lawsuits against this company.

Topic Author
sng
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Re: Health insurance cost containment company

Post by sng » Sat Jun 15, 2019 5:26 pm

Watty wrote:
Sat Jun 15, 2019 8:07 am
If you had travel insurance that would have likely paid for a lot of the costs while you were in Africa and Cigna wants to offload any costs that they can to the travel insurance company and make sure that you did not get paid by both companies. Likewise if you were traveling on business(which sounds unlikely) then your company could have had travel insurance that you don't even realize they have.

When you got the letters it was a mistake to ignore them, you should have verified that they were valid and then responded. There is likely something in the health insurance policy that requires you to work with them so not responding to a valid request for information was not an option.

You need to call them and try to get this straightened out. If you did have travel insurance and you just used Cigna because it was easier you may very well need to file the travel insurance claims and pay back Cigna.
Got it. Thanks! I have travel insurance but they are secondary to Cigna. The travel insurance only paid for the copay not covered by Cigna.

stlutz
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Re: Health insurance cost containment company

Post by stlutz » Sat Jun 15, 2019 5:56 pm

This is one of the challenges with healthcare is that most of us when we get such things in the mail are dealing with them the first time. I took a tumble when hiking one time and needed some stitches. Needless to say, getting this form caught me by surprise. I filled it out and that was it. That at least prepared me for when I got hit by a motorist quite a few years later--in that case I gave the form to my attorney and he took care of responding because then subrogation actually was involved.

quantAndHold
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Re: Health insurance cost containment company

Post by quantAndHold » Sat Jun 15, 2019 6:53 pm

Call them and find out why they think what they think.

Not saying you should pay them anything, but the subrogation letter is a normal thing when you have an accident, and it sounds like there may be some question about who should pay what on your claim. Find out what they want, then deal with it from there.

WillRetire
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Re: Health insurance cost containment company

Post by WillRetire » Sun Jun 16, 2019 8:45 am

A phone call to Accent in which you ask the questions is fine, but as for you providing information to them a 3rd party which you have no direct relationship with, I suggest doing 2 things instead:

1) Call Cigna back and ask them to confirm that Accent is authorized by Cigna to question you on this PERSONAL health incident,

and assuming Accent is authorized,

2) Write Accent a brief letter telling them the circumstances of the accident, in your words (and be very brief), to answer their inquiring minds searching for another entity to blame. If you like, also write on the questionnaire "see letter".
KEEP A COPY OF all documentation you send to Accent.

Until you know WHO authorized Accent to contact you about this PERSONAL health incident, give Accent nothing. Tell Cigna & Accent it is a HIPAA issue, and you fear a potential scam. Lay it on thick.

Shame on Cigna for not being more forthcoming.

InMyDreams
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Re: Health insurance cost containment company

Post by InMyDreams » Sun Jun 16, 2019 9:45 am

sng wrote:
Sat Jun 15, 2019 5:26 pm
I have travel insurance but they are secondary to Cigna. The travel insurance only paid for the copay not covered by Cigna.
This may be where Accent is trying to get a wedge in.

I'd also suggest finding out how to reach out to your state insurance commission, whatever their name may be. May you live in a state with strong consumer protection. I only had to mention to an insurance company that I was thinking about contacting my state's commission to make things go much more smoothly.

And, along that line - if this is employer based insurance, and you are still struggling with Cigna/Accent, you might contact your benefits office and complain about Cigna. The company pays Cigna, not you, so they have more leverage.

jminv
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Re: Health insurance cost containment company

Post by jminv » Sun Jun 16, 2019 10:27 am

sng wrote:
Sat Jun 15, 2019 5:24 pm
stlutz wrote:
Sat Jun 15, 2019 2:50 am
Are you/have you received reimbursement from somebody else who caused the accident? What is the background behind declining to provide the requested information?
No, I fell off the bicycle by myself. There is no one else responsible. I did not receive extra reimbursement from anyone else who is responsible. I only received reimbursement from my travel insurance for the medical copay not covered by Cigna. I am reluctant b/c I don't know this company and from searching online it appears there are lawsuits against this company.
Probably some of the things they want to know. You’re telling us but they don’t know, do they? That’s why they’re asking you for details.

Is your travel insurance actually secondary or did you decide to use them as secondary? I’m sure that’s an angle they’re after ie whether they can recover from your travel policy.

Lots of companies have lawsuits against them. That doesn’t mean you avoid what could be a legitimate request from them.

Call Cigna and straighten out whatever problem you have with them and their contractor. Avoiding Accents bill is probably not the way to go.

Broken Man 1999
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Re: Health insurance cost containment company

Post by Broken Man 1999 » Sun Jun 16, 2019 12:49 pm

awval999 wrote:
Sat Jun 15, 2019 8:02 am
You need to fill out the form. It's a normal subrogation form. The insurance company wants to go after someone else to refund them the money that they paid. They only want to pay if you caused the injury yourself.

My wife once dropped a bottle of sparking wine on the driveway, it broke, exploded and gashed her leg and needed stitches, bleeding everywhere, etc. Went to ER, got it fixed up. A month later a similar letter. I filled it out for her and she signed it. It was pretty clear what they were after, one of the questions was along the lines of, "was anyone else the cause of this injury" and I had to write out "[Mrs. awval999] dropped a bottle of sparkling wine on the driveway and it exploded causing injury".
I filled one out for Humana when I broke both legs in 2017. I'm sure they were hoping they could slide the costs to someone else.

They asked on the form "who was responsible for your accident?", I wrote ME, as I caused my own accident.

We all should be supportive in these activities as the cost containment efforts play a part (how much I have no idea) in premium setting, I would think.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

Topic Author
sng
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Re: Health insurance cost containment company

Post by sng » Sun Jun 16, 2019 3:30 pm

jminv wrote:
Sun Jun 16, 2019 10:27 am
sng wrote:
Sat Jun 15, 2019 5:24 pm
stlutz wrote:
Sat Jun 15, 2019 2:50 am
Are you/have you received reimbursement from somebody else who caused the accident? What is the background behind declining to provide the requested information?
No, I fell off the bicycle by myself. There is no one else responsible. I did not receive extra reimbursement from anyone else who is responsible. I only received reimbursement from my travel insurance for the medical copay not covered by Cigna. I am reluctant b/c I don't know this company and from searching online it appears there are lawsuits against this company.
Probably some of the things they want to know. You’re telling us but they don’t know, do they? That’s why they’re asking you for details.

Is your travel insurance actually secondary or did you decide to use them as secondary? I’m sure that’s an angle they’re after ie whether they can recover from your travel policy.

Lots of companies have lawsuits against them. That doesn’t mean you avoid what could be a legitimate request from them.

Call Cigna and straighten out whatever problem you have with them and their contractor. Avoiding Accents bill is probably not the way to go.
Thanks! I opened a case with my travel insurance company and they told me I have to file with Cigna first since the travel insurance is secondary. I remember looking at the travel policy and it is secondary. I sent my Cigna EOB to my travel insurance after Cigna processed my claim.

As mentioned earlier, when I called Cigna, they just said to call Accent and would not comment any further.

I don't know Accent and don't have any business relationship with them so I was wary of just providing any info to any company that just sent me a letter.

Topic Author
sng
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Re: Health insurance cost containment company

Post by sng » Sun Jun 16, 2019 3:56 pm

Broken Man 1999 wrote:
Sun Jun 16, 2019 12:49 pm
awval999 wrote:
Sat Jun 15, 2019 8:02 am
You need to fill out the form. It's a normal subrogation form. The insurance company wants to go after someone else to refund them the money that they paid. They only want to pay if you caused the injury yourself.

My wife once dropped a bottle of sparking wine on the driveway, it broke, exploded and gashed her leg and needed stitches, bleeding everywhere, etc. Went to ER, got it fixed up. A month later a similar letter. I filled it out for her and she signed it. It was pretty clear what they were after, one of the questions was along the lines of, "was anyone else the cause of this injury" and I had to write out "[Mrs. awval999] dropped a bottle of sparkling wine on the driveway and it exploded causing injury".
I filled one out for Humana when I broke both legs in 2017. I'm sure they were hoping they could slide the costs to someone else.

They asked on the form "who was responsible for your accident?", I wrote ME, as I caused my own accident.

We all should be supportive in these activities as the cost containment efforts play a part (how much I have no idea) in premium setting, I would think.

Broken Man 1999
Thanks! My general wariness is the fact that it's not Cigna who is contacting me. When I call Cigna, they just told me to contact Accent and would not comment on anything else. Also Cigna said there is no change to my EOB. I hate to get entangled with a company that I don't have any direct business relationship with and it doesn't appear that Cigna want to get involved with this at all.

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dm200
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Re: Health insurance cost containment company

Post by dm200 » Sun Jun 16, 2019 4:02 pm

HomeStretch wrote:
Sat Jun 15, 2019 7:29 am
As another poster said, this is a normal insurance company request. You should call Accent and provide the requested information.
Yes - fill out the forms. etc and cooperate fully.

For example, both my wife and I are on Medicare and have no other health insurance. BUT, every year we get a form from our Medicare provider (Kaiser) asking for other/employer insurance.

Likewise, when checking in for most Kaiser appointments, they ask if I am there due to accident, workplace injury, etc. They want to make sure no other party or insurance company can be involved or obligated.

David S
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Re: Health insurance cost containment company

Post by David S » Mon Jun 17, 2019 9:10 pm

I would continue to simply ignore Accent and their requests for information. Several posters have said this is a “normal insurance company request,” but it’s not coming from your insurance company – it’s coming from a third party hired by them with whom you have no relationship.
Accent says on their website that their mission is to “improve the bottom line” of their clients (Cigna and other insurance companies) by data mining, among other things. I guarantee you that they do not have your best interests at heart. In fact, they’ve tried to bully you into returning money to them before they’ve even gotten any additional information from you.
Your current situation appears to be that both you and your insurance company have reached an equitable settlement on your medical claims. You, rightly, called to verify this and they’ve confirmed that there has been no re-opened claim and no changed EOB. And yet, Accent claims there was a mis-payment? Seems that Cigna would be aware of this if it were the case. I would simply steer clear of them. They are hired guns looking for any “do over” that they can find. And it says a lot that your Cigna rep knew who they were but didn’t want to comment about them.
If the letters continue, I would simply write them back and inform them that you’ve reported their harassment to your state insurance commissioner, with a copy to Cigna.

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southerndoc
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Re: Health insurance cost containment company

Post by southerndoc » Mon Jun 17, 2019 11:24 pm

sng wrote:
Sat Jun 15, 2019 5:24 pm
stlutz wrote:
Sat Jun 15, 2019 2:50 am
Are you/have you received reimbursement from somebody else who caused the accident? What is the background behind declining to provide the requested information?
No, I fell off the bicycle by myself. There is no one else responsible. I did not receive extra reimbursement from anyone else who is responsible. I only received reimbursement from my travel insurance for the medical copay not covered by Cigna. I am reluctant b/c I don't know this company and from searching online it appears there are lawsuits against this company.
They probably want to know where you rented the bicycle, if the bicycle owner had separate insurance that covered your injury, if someone else was at fault, etc.

As another poster has pointed out, you should not have ignored the original letters. It may be too late to not have to repay Cigna. Failure to do so may result in litigation against you, liens, etc.

This is common among insurers. I've been deposed in litigation where an insurance company is suing an individual or their insurance for car accidents. Definitely not unusual.

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southerndoc
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Re: Health insurance cost containment company

Post by southerndoc » Mon Jun 17, 2019 11:28 pm

sng wrote:
Sun Jun 16, 2019 3:56 pm
Broken Man 1999 wrote:
Sun Jun 16, 2019 12:49 pm
awval999 wrote:
Sat Jun 15, 2019 8:02 am
You need to fill out the form. It's a normal subrogation form. The insurance company wants to go after someone else to refund them the money that they paid. They only want to pay if you caused the injury yourself.

My wife once dropped a bottle of sparking wine on the driveway, it broke, exploded and gashed her leg and needed stitches, bleeding everywhere, etc. Went to ER, got it fixed up. A month later a similar letter. I filled it out for her and she signed it. It was pretty clear what they were after, one of the questions was along the lines of, "was anyone else the cause of this injury" and I had to write out "[Mrs. awval999] dropped a bottle of sparkling wine on the driveway and it exploded causing injury".
I filled one out for Humana when I broke both legs in 2017. I'm sure they were hoping they could slide the costs to someone else.

They asked on the form "who was responsible for your accident?", I wrote ME, as I caused my own accident.

We all should be supportive in these activities as the cost containment efforts play a part (how much I have no idea) in premium setting, I would think.

Broken Man 1999
Thanks! My general wariness is the fact that it's not Cigna who is contacting me. When I call Cigna, they just told me to contact Accent and would not comment on anything else. Also Cigna said there is no change to my EOB. I hate to get entangled with a company that I don't have any direct business relationship with and it doesn't appear that Cigna want to get involved with this at all.
I may be completely wrong here, but for some reason I think that insurance companies cannot do this retrospectively and must have a third party administrator ("auditor") perform this to recover unnecessary expenses. Cigna contracting with Accent is no different than CMS contracting with numerous RAC's (recovery auditor contractors).

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Nate79
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Re: Health insurance cost containment company

Post by Nate79 » Tue Jun 18, 2019 7:29 am

sng wrote:
Sun Jun 16, 2019 3:56 pm
Broken Man 1999 wrote:
Sun Jun 16, 2019 12:49 pm
awval999 wrote:
Sat Jun 15, 2019 8:02 am
You need to fill out the form. It's a normal subrogation form. The insurance company wants to go after someone else to refund them the money that they paid. They only want to pay if you caused the injury yourself.

My wife once dropped a bottle of sparking wine on the driveway, it broke, exploded and gashed her leg and needed stitches, bleeding everywhere, etc. Went to ER, got it fixed up. A month later a similar letter. I filled it out for her and she signed it. It was pretty clear what they were after, one of the questions was along the lines of, "was anyone else the cause of this injury" and I had to write out "[Mrs. awval999] dropped a bottle of sparkling wine on the driveway and it exploded causing injury".
I filled one out for Humana when I broke both legs in 2017. I'm sure they were hoping they could slide the costs to someone else.

They asked on the form "who was responsible for your accident?", I wrote ME, as I caused my own accident.

We all should be supportive in these activities as the cost containment efforts play a part (how much I have no idea) in premium setting, I would think.

Broken Man 1999
Thanks! My general wariness is the fact that it's not Cigna who is contacting me. When I call Cigna, they just told me to contact Accent and would not comment on anything else. Also Cigna said there is no change to my EOB. I hate to get entangled with a company that I don't have any direct business relationship with and it doesn't appear that Cigna want to get involved with this at all.
Cigna told you to contact them. Why haven't you?

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Watty
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Re: Health insurance cost containment company

Post by Watty » Tue Jun 18, 2019 8:59 am

southerndoc wrote:
Mon Jun 17, 2019 11:28 pm
I may be completely wrong here, but for some reason I think that insurance companies cannot do this retrospectively and must have a third party administrator ("auditor") perform this to recover unnecessary expenses.
One thing to remember is that Cigna's lawyers pretty much wrote the health insurance contract by themself so it is likely very favorable to them.

I would not be surprised it they could designate some other company to act on their behalf whenever they wanted.

I would also be concerned that there is likely an arbitration clause in the contract that would allow them to recover the funds without even going to court. Typically the arbitrator specified in contracts is chosen because they are very favorable to whoever wrote the contract.

In arbitration it could be pretty cut and dried if all they have to show is that the OP did not cooperate with them(or their designee) as required in the contract.

The OP really needs to go into damage control mode and contact them to work this out.

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dm200
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Re: Health insurance cost containment company

Post by dm200 » Tue Jun 18, 2019 9:09 am

Please let us know how this works out.

An acquaintance of mine was injured (as a pedestrian) in Canada - and received excellent care there for his leg injuries.

He is insured here by Kaiser - and there was a lot of paperwork between Kaiser and the Canadian providers about his treatments, costs, etc. All worked out ok, in the end, for him.

Again, I would cooperate with all involved - BUT hold back on paying back unless this is the correct resolution. Medical care and the costs in other countries gets complicated.

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