问 HN：有哪些关于健康保险拒付的最佳资源？
2 分•作者: cigna•6 个月前
2023年末，我在美国境外产生了住院费用，自付了大约3000美元。我向信诺（Cigna）提交了理赔申请，尽管收到了提交成功的电子邮件确认，但直到2024年（由保险提供方——我的雇主Zoox介入后），我才在信诺的仪表盘上看到这些申请。
Zoox最初对促使信诺处理我的理赔申请有所帮助，并告知我信诺需要补充哪些信息。但信诺给出的拒绝理赔理由前后矛盾，包括说我需要重新提交申请，因为我的保险计划“由不同的部门处理”，以及“供应商中断……导致许多[我的]理赔申请无法通过”。此外，我至少两次通过在线聊天与信诺沟通，但每次都在客服要求更多时间后，聊天就中断了。
与信诺的对话记录：https://docs.google.com/document/d/1dNDsCJ0_LSed4CmCmkSPQYMA-MpDPL6vg9lVRR1rgOY/edit?usp=sharing
最终，Zoox也停止了回复，尽管我通过电子邮件进行了几次跟进。
有什么办法能让信诺对我的理赔申请进行诚意审查吗？是否有政府机构或外部公司可以帮助我进行申诉？
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In late 2023, I had hospital expenses outside of the USA, and spent about $3k out of pocket. I submitted the claims to Cigna, but even though I got email confirmations of my submission, it was only until 2024 (when Zoox, the employer who the insurance was through, got involved) that I could see the claims in my Cigna dashboard.<p>Zoox was initially helpful in getting Cigna to respond to the claims, and they let me know what additional information Cigna needed. Cigna gave inconsistent reasons for why my claims were rejected, including saying that I needed to resubmit due to my plan being 'handled by different department', and that a 'vendor outage... prevented many of [my] claims to come through’. There have also been at least two times that I have talked with Cigna over chat, only to have the chat die after the agent asks for more and more time.<p>Conversations with Cigna: https://docs.google.com/document/d/1dNDsCJ0_LSed4CmCmkSPQYMA-MpDPL6vg9lVRR1rgOY/edit?usp=sharing<p>Eventually, Zoox stopped responding as well, though I have a followed up a few times through email.<p>Is there any way to get Cigna to have a good faith review of my claims? Any government agencies that can help me, or outside companies that can help with the appeal?