Cigna denied prior authorization? Here’s what to do

Why Cigna denied prior authorization

• The request lacked a letter of medical necessity or clinical notes.
• Cigna considers the service experimental or not medically necessary.
• A formulary or step-therapy rule required trying another option first.
• The request used the wrong code or was missing supporting records.

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. 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 get the precise reason for the prior-auth denial.
2. Ask your prescriber to submit a letter of medical necessity with clinical notes.
3. Request a peer-to-peer review between your doctor and the Cigna medical director.
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.
5. If your health is at risk, request an expedited (urgent) appeal.

Common mistakes to avoid

• Waiting on the doctor’s office instead of driving the appeal yourself.
• Skipping the peer-to-peer review, which often resolves the denial fastest.
• Not requesting an expedited appeal when the delay could harm your health.

What to say when you call Cigna

• I’m appealing a prior-authorization denial and want to schedule a peer-to-peer review.
• Please tell me exactly what clinical documentation is missing.
• If this is time-sensitive, I’m requesting an expedited appeal.

Cigna-specific things to know

• Cigna prior-auth requests are usually filed by your provider; the peer-to-peer review is scheduled through the provider services line, so loop your doctor’s office in early.
• Behavioral-health and pharmacy prior auths go through Evernorth, which has its own appeal address.
• 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: prior authorization denial
• Aetna: prior authorization denial
• UnitedHealthcare: prior authorization denial
• Cigna: denied claim
• Cigna: surprise medical bill
• Cigna: out-of-network coverage