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If you are covered under a health insurance policy or a health plan offered by a health maintenance organization HMO , the state insurance department or other government agency may be able to assist you in resolving your dispute.
If your benefits plan is self-insured by your employer, your employer may have elected not to offer external review. Check with your employer or in your summary plan description for more options. In most cases, you must complete the Cigna internal appeal process described above before pursuing arbitration or legal action.
You may also want to consider taking advantage of the independent external review that may be available. To learn more about the appeal process, call customer service at the number on your Cigna ID card.
What is Prior Authorization? View all articles. All rights reserved. Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.
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Special Enrollment See all topics Looking for Medicare coverage? Shop for Medicare plans. Member Guide. Find a Doctor. If customer service is unable to resolve your concern, ask the representative how to appeal.
If you are not satisfied, we will provide information on other options that may be available. To file an appeal or grievance: Go to Customer Forms Or, if you're a myCigna user, log in to myCigna and go to the Forms Center Learn about appeals for Medicare plans How to request an appeal if you have a plan through your employer The appeal process you must follow is determined by the benefits plan your employer has chosen and follows state and federal rules specific to your benefits plan.
To begin the process, call customer service at the telephone number on your Cigna ID card within calendar days of the date of the initial payment or denial notice Explain why you believe the initial decision should be reconsidered Along with your written appeal request or promptly after you request an appeal by phone include any documentation that supports your argument.
Home Providers Coverage and Claims. Coverage and Claims We take on the administrative burden so you can focus on getting patients the care they need, and get paid in a timely manner. Prior Authorizations Request a specific medication or care for a patient. Coverage Policies Get assistance interpreting standard health coverage plan provisions. Claims Guides to setting up clean claims and timely filing. Payments How to set up direct deposits and handle overpayments.
Referrals In-Network and Out-of-Network referral details. Appeals and Disputes Policy and procedures to resolve claims disputes. We're here to help. Pharmacy Email us.