How to Appeal to Cigna Ltd.

When Cigna issues a denial of care or claims, the Cigna health plan member, her representative or the provider has the option to appeal the decision. Cigna offers two levels of appeals, which means if the first level appeal does not overturn the original decision, the appellant can initiate a second level of appeal. A new set of reviewers will examine the appeal and make a determination. Beyond the second appeal, a third level of appeal may be available to Cigna members, and an arbitration process is offered to providers.

Instructions

• 1

  Review the denial letter and/or explanation of benefits statement that contains a denial of services or claims. Make sure you understand the reason for the denial. If you need further clarification, call Cigna at the phone number listed on these documents.

• 2

  Collect all written documentation, such as medical records, correspondence from Cigna, summary plan description and letter from your doctor's office, that supports why the denial should be overturned.

• 3

  Call the Cigna member services department and request to file a first-level appeal. A provider or legal representative can also file an appeal on your behalf. You also have the option of filing a written appeal. Let the representative know you have supporting documentation to corroborate your appeal request. If the provider is initiating the appeal, he must do so in writing within 180 calendar days of the date of the initial payment or denial notice.

• 4

  Continue to file appeals until either you have reached the final level of appeal available or the original decision is overturned. Cigna offers at least two levels of appeal. Depending on your benefit plan, you may have an additional level of review by an external reviewer. The external reviewers do not work for Cigna and have not seen your information prior to reviewing your appeal. A provider must file a second-level appeal in writing; if that fails, the provider can move to binding arbitration.

• 5

  Call Cigna to ask if you have an arbitration option, after exhausting all appeals without a favorable decision to you. Providers will have the option of arbitration, per their network agreement with Cigna. Consult with an attorney and your state's department of insurance for assistance if you feel you have a strong case and wish to move forward.