Cigna denied out-of-network coverage? Here’s what to do

Why Cigna denied out-of-network coverage

• No in-network provider offered the needed service within a reasonable distance or time.
• Continuity-of-care rules were not applied after a provider left the network.
• The claim was processed at out-of-network rates by default.

Step by step: what to do

1. Call Cigna at 1-800-244-6224 and ask whether an in-network provider was actually available.
2. Request a network-adequacy or gap exception so the care is covered in-network.
3. Provide documentation that no suitable in-network option existed.
4. File a written 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.

Common mistakes to avoid

• Assuming out-of-network always means no coverage — exceptions exist.
• Not documenting the lack of an in-network option.

What to say when you call Cigna

• There was no in-network provider available, so I’m requesting a network-adequacy exception.
• Please reprocess this at the in-network benefit level.

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.

Frequently asked questions

Related guides

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