If I use my benefits, will I have a lot of paperwork?
If you go to an independent behavioral health professional within
the CIGNA Behavioral Health network, we handle all the paperwork and
claims forms. If you opt for an out-of-network professional, and
your benefits cover out-of-network services, you will most likely
need to file a claim. With most plans, you will also be required to
pay a larger portion of the costs yourself. Please consult your
benefit plan summary for details. Call CIGNA at the number on the back of your ID card
to receive a claim form if you will be submitting claims for reimbursement.
Where do I mail out-of-network claims?
CIGNA Behavioral Health
P.O. Box 46270
Eden Prairie, MN 55344-6270
What if I get a claim denial?
First, you must remain eligible in order for CIGNA Behavioral Health
to cover the service - even if coverage was pre-authorized for
non-routine levels of care. When seeing an in-network contracted
provider, claims are handled for you by your contracted behavioral
health professional. On rare occasions, when services are not
reimbursed, call CIGNA at the number on the back of your ID card.
The most common factors for claim denial are:
- Benefit authorization is not in place to cover the date
when service was rendered. This suggests that you did
not get pre-authorized coverage for the services you
received. Pre-authorization of coverage is typically only
required if you are not being seen 'outpatient' for a
routine office visit with a CIGNA Behavioral Health
contracted provider.
- Eligibility is not confirmed for the date when
service was rendered. This suggests that your benefit plan
was not in effect when the services were received.
- Behavioral health professional is out-of-network.
This suggests that you went to a professional who does not
participate in the CIGNA Behavioral Health network, and your
benefits do not apply to out-of-network services. You may
check the status of your behavioral health professional by
calling the toll-free number on your insurance ID card.
If you are being billed by your behavioral health professional due
to a claim denial, you may wish to speak directly with CIGNA
Behavioral Health to get more information about the denial.
What if my medication isn't covered?
CIGNA Behavioral Health does not administer the pharmacy benefits
portion of your health benefit, but we will work with you to
determine what the problem may be and who to call to try to get the
situation fixed.
Most common explanations when a medication is not covered:
- Behavioral health professional is out-of-network Your
pharmacy benefits may not apply to prescriptions written by
an out-of-network psychiatrist.
- The prescribed medication is not on the formulary A
formulary is the list of drugs covered by your pharmacy
benefits. (Please note that not all plans use a formulary.)
You may check to see whether your prescribed medication is
on the formulary by calling your medical carrier's tool-free
number (found on your insurance ID card) or checking their
Web site. If it is not, you will want to discuss this with
your psychiatrist. He/she will determine if an alternative
medication on the formulary is appropriate for you. If one
is not, your psychiatrist may submit a written appeal for
exception to the company that handles your pharmacy
benefits.
If you feel that a medication prescribed by your psychiatrist or
nurse practitioner should be covered, please call us at the
toll-free number on your insurance ID card, or call your medical
carrier for immediate assistance.
What do I do if I have questions about my claim?
In general, if you have a behavioral health claim
question, you can call CIGNA Behavioral Health
Customer Service at the number on the back of your ID card.
Not all claims for Mental Health/Substance Abuse are paid
by CIGNA Behavioral Health, however. Some
accounts have a dedicated Customer Service/Claim
line and you should dial that number for answers
to your questions if your benefit plan is set up
as such.
This material is provided by CIGNA Behavioral Health, Inc. for
informational/educational purposes only. It is not intended as
medical/clinical advice. Only a healthcare provider can make a
diagnosis or recommend a treatment plan.
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