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This webpage is an outline of important medical and dental coverage information. We know insurance can be complex and confusing. That's why we try to make it as easy-to-understand as possible. Because, if you know how your coverage works, you'll know how to get the most out of your plan. If you have a question about your Cigna Individual and Family insurance plan, please contact us.
We're here to help. Just call Cigna Customer Service. Do this before you apply for coverage. To find information related to your state, visit Health Insurance Plans for Individuals and Families. If you have difficulty reading English, we offer language help. For help please call Customer Service. Once connected, please enter or provide the toll free number you're calling. This is important information. If you visit an out-of-network provider, you may pay more.
Out-of-network providers do not have a contract with Cigna at the time you receive services. These providers include doctors, hospitals, clinics, pharmacies and labs. Also, some health plans do not cover services provided by an out-of-network provider, except:. Your health plan does not cover non-emergency services from an out-of-network provider.
You will pay a larger part of the cost share for those services than you would for the same services provided by an in-network provider. This may include the deductible, coinsurance and other out-of-pocket amounts. In addition, you may have to pay the difference between what the plan allows and the amount billed by the provider.
This is called Balance Billing. Balance Billing is the difference between the out-of-network provider's charge and Cigna's allowed amount for the service s. An in-network provider may not bill you for the difference between their charge and Cigna's negotiated rate. When you visit an in-network provider, show your ID card and pay any required copay. After your visit, the provider will send a bill to us. We refer to a bill as a claim. We will process the claim according to the terms of your insurance plan and any payment due will be made to the provider directly.
When you visit an out-of-network provider, show your ID card and ask the provider if they will bill your insurance company. Out-of-network providers may agree to submit a bill on your behalf, but they are not required to. We will process the claim according to the terms of your insurance plan. If authorized by you, any payment due will be made to the provider. Otherwise, any payment due will be made to you. If your provider does not agree to submit a bill on your behalf, you must send a completed claim form and an itemized bill to the address listed on your ID card.
Or, you can call the Customer Service number on your ID card for information about how to submit a claim. To pay a claim, Cigna must receive the claim by a certain date. Access the required claim forms for medical, behavioral, pharmacy, vision and dental. Medical Claims: Use the mailing address provided on your ID card. Attn: Claims Service Dept. Box Chattanooga, TN To keep your health insurance coverage in effect, you must pay the monthly bill.
We call this the premium payment. If you do not pay the monthly bill, then there is a grace period. You still have coverage during the grace period. A grace period is a short span of time after the date your premium is due. If you fail to pay premium within the grace period, your coverage may be rescinded or cancelled. Rescission of your coverage will result in denial of all pending claims and, if claim payments exceed total premiums paid, then claims already paid by Cigna may be retroactively denied.
Did you go to a provider and your claim was paid by Cigna, but then later denied? You will receive an Explanation of Benefits detailing how Cigna handled your claim. If your claim was not paid, the Explanation of Benefits will provide the reason why it was denied. You have the right to appeal when a claim is not paid. Appeal rights and timeframes can vary from state to state. Your policy will include full information on your grievance and appeal rights.
A denied claim means Cigna is not paying for the services you received. A retroactive denial is a claim paid by Cigna and then later denied, requiring you to pay for the services. Learn more about appeals and grievances. If you overpaid your insurance premium, you may qualify for a refund. If you think you overpaid, Cigna's Billing and Enrollment department can help you. Please call the number on the back of your ID card with questions about your premium payment and possible refund.
Do you need approval before a non-emergency hospital stay or having outpatient care? You may need to get Cigna's approval before a hospital stay or outpatient care. Getting approval is also called prior authorization. Please note: We will review emergency admissions or care after you receive them to determine whether the services were emergent and medically necessary.
A service is medically necessary if it is appropriate and necessary to treat your medical condition. The service must also be consistent with sound medical practice.
Your health insurance plan has its own list of covered drugs, also called the Prescription Drug List. The amount covered for your drugs depends on your plan, the drug and the state where you live. To find out what drugs are covered on your plan, use the drug search tool and select the state you live in. Some prescription drugs and related supplies may need prior authorization from Cigna. This means we have to approve coverage before your doctor can prescribe them. Sometimes our members need access to drugs that are not listed on our drug list.
There is a process for requesting a prescription drug exception. How to complete the pharmacy form for a prior authorization or exception request:.
The prescription will be covered at same benefit level as a Participating Pharmacy. The exception request is initially reviewed by Cigna through the formulary exception review process. If you don't like Cigna's decision about your drug claim, you can request that we look at the claim again.
Just submit a written appeal. Tell us in the appeal why the prescription drugs or related supplies should be covered. If you have questions about exceptions or prior authorizations, call Customer Service.
Just call the toll-free number on your ID card. Box Chattanooga TN For mail-order pharmacy claims: Express Scripts P. Box St. Louis MO As part of your plan, we're at your service. If you have questions about your medications, contact us. We have information about side effects, and how some medications interact with other medications. We can let you know how to handle or store them too. Your doctor's office submits a claim for payment to Cigna after you see your doctor or receive other medical care.
If your provider is not submitting a claim on your behalf, you must send a completed claim form and an itemized bill to the address listed on your ID card. It tells you how your claim was paid, including the amount that was paid and to whom it was paid. EOBs are available for you to look at online at www. You'll also find:. Remember to save your EOBs for tax purposes and as a record of health care dates and services. When two plans cover the same service they may coordinate benefits. This is so that neither plan duplicates the other plan's payment.
Coordination of Benefits rules can vary from state to state. Please refer to your policy for more information on "Coordination of Benefits. Member Services. To engage in a Cigna Plan network, visit our credentialing page. For answers to our most frequently asked financial questions, visit our Financial FAQ section.
Institutional Investors and Analysts If you are a current or prospective investor in Cigna and have questions about our business, please contact:. Giacobbe cigna. Crompton cigna. Individual Shareholders If you are a current or prospective Cigna common-stock shareholder and have questions about the Direct Stock Purchase Plan, dividend payments or stock transfers, please contact:. Phone Numbers domestic international. Current Customers For questions about your plan, coverage, reimbursements, and more, call the phone number on your ID card.
Lost ID Cards. For current press and media inquiries, visit our media resource center. For inquiries or requests, please email us. You can begin searching for jobs on the Cigna Career website. All rights reserved. All insurance policies and group benefit plans contain exclusions and limitations.
For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico. Selecting these links will take you away from Cigna.
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