When the Cigna appeals process has been exhausted, what happens if the provider still disagrees with the decision

Answerrule utilitarianism;

Why is customer awareness a synonym of customer responsibility?   because both customer awareness and customer responsibility refer to the  understanding of the individual rights the person/consumer has regarding products for purchase. this allows the consumer to make their selection based of choice, price, safety and other attributes that differentiates different brands. 

Iwould start by thinking of two variables, first, d to lower the risk of the over all company.  then, after you would raise the deductibles. which is usually only after you have lowered the risk