VERIFYING AVAILABLE BENEFIT PACKAGES

Just as important as identifying a CIGNA participant is verifying that participant’s available benefit package. A participant’s benefit package can vary from one CIGNA participant to the next. As an example, one participant’s benefit package may cover substance abuse outpatient group therapy, while another participant’s package does not.

It is important for both you and your patient to review available benefits, so that financial responsibility may be discussed and understood at the start of treatment. If a claim is submitted and administratively denied because the services are not covered by a participant’s benefit package, you must hold the participant financially harmless for the charge, unless a detailed self-pay agreement was created and signed by the participant in advance of services. To verify benefit information, please call the number on the back of the participant’s member identification card. If a participant does not have a health care ID card, ask the participant for the information below:

Participant Information
Participant Name
Zip Code
Date of Birth
Subscriber ID #

Plan Subscriber Information Name
Participant Number
Subscriber ID #
Date of Birth
Zip Code

After obtaining this information, please call CIGNA or go online to www.cignabehavioral.com to verify eligibility and benefits for the participant.

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