Cigna denied your claim? Here’s what to do

What to gather first

• Your denial letter and the Explanation of Benefits (EOB), which state the exact reason.
• Your member ID, the claim number, and your plan documents (Evidence of Coverage / Summary of Benefits).
• The original bills and medical records for the service.
• A letter of medical necessity from your doctor (or notes you can ask them to provide).
• Dated notes from every call with Cigna or your provider.

Why Cigna denied your claim

• A coding or paperwork error by the provider (the most common cause).
• The service was billed as "not medically necessary" or experimental.
• Missing prior authorization or a referral.
• The claim was sent to the wrong plan or filed after the timely-filing window.
• An out-of-network provider where Cigna expected in-network.

Calling Cigna: what to expect

Cigna’s line is 1-800-244-6224; member services is typically staffed around the clock for medical plans; the number on the back of your ID card is the fastest route.

To reach a person: say or enter your Cigna ID number when prompted, then say "claims" for a claim or denial, or "prior authorization" for a pending request, then say "representative" if the automated system keeps looping. Menus change — if yours does not match, say "representative" at any prompt.

Self-service runs through myCigna (https://my.cigna.com); the written route is the Cigna Customer Appeal Request form (also accepted as a plain letter to the appeals address on your EOB); and you may see these names on your paperwork: myCigna, Cigna Healthy Today, Evernorth (pharmacy and behavioral health).

Step by step: what to do

1. Read the denial letter and EOB for the exact denial code and reason — that is your roadmap.
2. Call Cigna at 1-800-244-6224 (say or enter your Cigna ID number when prompted, then say "claims" for a claim or denial, or "prior authorization" for a pending request, then say "representative" if the automated system keeps looping) and ask for the specific plan language the denial relies on.
3. Request a full copy of your plan documents and the claim file.
4. Ask the provider to correct any coding error and resubmit, if that is the cause.
5. Write an appeal letter with your name, member ID, and claim number; state plainly why it should be covered and attach your supporting records.
6. File the written internal appeal through the appeal address on your denial letter or the myCigna member portal before the 180 days from the date of the denial deadline (keep proof of the date sent).
7. If the internal appeal is denied, request an independent external review by a reviewer who does not work for Cigna.

Common mistakes to avoid

• Treating the first phone "no" as final — denials must be appealed in writing.
• Missing the 180 days from the date of the denial appeal deadline.
• Appealing without citing the specific denial code and plan language.
• Not asking your doctor for a letter of medical necessity, which often decides the appeal.
• Stopping after the internal appeal instead of using your external-review right.

What to say when you call Cigna

• I’m calling about a denied claim and I want to start a formal appeal.
• Please tell me the exact denial code and the plan provision it’s based on.
• I’m requesting a full copy of my plan documents and claim file.
• Please confirm the appeal deadline and the address or portal for my written appeal.

Cigna-specific things to know

• Cigna denial letters carry a specific "remark code" — reading it back to the rep skips a lot of back-and-forth, and myCigna shows it under the claim detail.
• For employer (self-funded) plans, Cigna is the administrator, not the insurer — your appeal is still filed with Cigna but the plan document controls.
• Pharmacy and behavioral-health denials are usually handled by Evernorth (Express Scripts) rather than the medical line — check which company name is on the denial.
• The number on the back of your ID card routes to the team for your specific plan; the general 1-800 number adds a transfer.
• Cigna posts EOBs and denial letters in myCigna within a few days, so you can pull the denial code before you call.
• Cigna is a common administrator for self-funded employer plans, where the employer sets the coverage rules — ask whether your plan is "fully insured" or "self-funded" because it changes who decides the appeal.

Know your rights

You have the right to a written explanation of any denial, to a full copy of your plan documents, and to appeal — first internally, then through an independent external review.

Regulator: your state Department of Insurance (and the federal No Surprises Act). If the internal appeal fails, request an external review and file a complaint with your state Department of Insurance.

If Cigna will not move, the escalation paths that carry weight:

• Ask for a second-level internal appeal if the first is denied; many Cigna plans offer two internal levels.
• Request an independent external review once internal appeals are exhausted — for employer plans that runs through Cigna’s external-review vendor, for individual plans through your state Department of Insurance.
• File a complaint with your state Department of Insurance, or with the U.S. Department of Labor if your plan is through an employer.

Frequently asked questions

Related guides

• Anthem: denied claim
• Aetna: denied claim
• UnitedHealthcare: denied claim
• Cigna: prior authorization denial
• Cigna: surprise medical bill
• Cigna: out-of-network coverage