NaviNet is a free, Internet-based application for providers to streamline data exchanges between their offices and Highmark. The waiver of Highmark member cost-sharing for in-network telehealth visits is effective for electrolysis amerigroup of service from March 13 international claims June 30, Please carefully read and follow the instructions contained within the individual form for submission. Health Options Provider Manual. Medical Policy Medical Policy. This partnership is instrumental in bringing a personalized care transitions approach to support Highmark's Medicare Advantage members across Pennsylvania and West Virginia. Contact Us.
Looking for a new Cigna Medicare Advantage Plan? Call toll free:. For TTY service for hearing impaired callers, call for Telecommunications Relay Service and enter the toll free number you are calling.
April 1 September Monday Friday am pm, Messaging service used weekends, after hours, and Federal holidays. Looking for information on your current Cigna Medicare Advantage Plan? Box Nashville, TN April 1 September Monday Friday am pm Arizona time. Voicemail available on weekends and Federal Holidays. Box Phoenix, AZ Our automated phone system may answer your call during weekends from April 1 September Box Weston, FL Call toll free: TTY All rights reserved. All insurance policies and group benefit plans contain exclusions and limitations.
For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico. As part of your plan, we're at your service. If you have questions about your medications, contact us.
We have information about side effects, and how some medications interact with other medications. We can let you know how to handle or store them too.
Your doctor's office submits a claim for payment to Cigna after you see your doctor or receive other medical care. If your provider is not submitting a claim on your behalf, you must send a completed claim form and an itemized bill to the address listed on your ID card. It tells you how your claim was paid, including the amount that was paid and to whom it was paid.
EOBs are available for you to look at online at www. You'll also find:. Remember to save your EOBs for tax purposes and as a record of health care dates and services. When two plans cover the same service they may coordinate benefits. This is so that neither plan duplicates the other plan's payment. Coordination of Benefits rules can vary from state to state. Please refer to your policy for more information on "Coordination of Benefits.
If you visit an out-of-network dentist or other provider , you may pay more for services. You may have to pay the difference between what the plan allows and the amount billed by the dentist. Balance Billing is the difference between the out-of-network dentist's charge and Cigna's allowed amount for the service s.
An in-network dentist may not bill you for the difference between their charge and Cigna's negotiated rate. For in-network dental claims, your provider will submit your claim. Cigna will process the claim according to the terms of your insurance plan and any payment due will be made to the provider directly.
For out-of-network dental claims, Cigna must receive your claim within 12 months after the date of service, except in absence of legal capacity. If your dentist is not submitting a claim on your behalf, you must send a completed claim form and itemized bill to Cigna. View Cigna's dental claim forms. To keep your dental insurance coverage in effect, you must pay the monthly bill. If you do not pay your monthly bill, then there is a grace period. If you bought your plan from a state or federal marketplace AND you qualify for federal financial assistance and receive an advanced premium tax credit:.
Did you go to a dentist and your claim was paid by Cigna, but then later denied? A denied claim means that Cigna will not pay for the services you received. If you overpaid your insurance premium you may qualify for a refund. You or your dentist's office will submit a claim for payment to Cigna after you visit your dentist. It's simple and clear, so you can see what was submitted, what's been paid and what you owe. EOBs are available for you to look at online at myCigna. Remember to save your EOBs for tax purposes and as a record of dental care dates and services.
Some insured people may have two dental plans. If you do, your Cigna dental plan will cover services according to the terms of your Cigna dental plan. Cigna does not coordinate benefits for dental coverage. All rights reserved. Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations.
For costs and details of coverage, review your plan documents or contact a Cigna representative. Selecting these links will take you away from Cigna. Cigna may not control the content or links of non-Cigna websites. Special Enrollment See all topics Looking for Medicare coverage?
Shop for Medicare plans. Member Guide. Find a Doctor. What does QHP transparency in coverage mean? Out-of-network non-emergency services Your health plan does not cover non-emergency services from an out-of-network provider. Enrollee Claim Submission How you get your bill paid when visiting an in-network provider When you visit an in-network provider, show your ID card and pay any required copay. How you get your bill paid when visiting an out-of-network provider When you visit an out-of-network provider, show your ID card and ask the provider if they will bill your insurance company.
Medical Claims must be received by Cigna within 15 months of the original date of service, except in the event of a legal incapacity. Pediatric Vision Claims must be received by Cigna within 12 months of the original date of service, except in the event of a legal incapacity. Claim forms Access the required claim forms for medical, behavioral, pharmacy, vision and dental. Mail your completed claim form s and the original itemized bill s to Cigna. You will receive an Explanation of Benefits after your claim is processed.
If you are unable to find a claim form or need help, please call Customer Service. If your claim is not approved or denied it is referred to as pending.
As long as initial payment for coverage has been paid and the plan is active, you have 31 days to pay your bill or premium. Coverage will continue during the grace period. If you fail to pay premium within the applicable grace period, your coverage may be rescinded or cancelled. As long as initial payment for coverage has been paid and the plan is active, you have 3 months to pay your bill or premium.
Services received during the grace period. If you receive services during the grace period and receive an Advanced Premium Tax Credit: Cigna will pay claims for covered services during the first 30 days of the grace period. Cigna will hold or pend claims for covered services received during the second and third month of the grace period.
Retroactive Denials Did you go to a provider and your claim was denied? A retroactive denial could be due to: Eligibility issues Service s determined to be not covered by your policy Rescission or cancellation of coverage Ways to avoid denied claims: Pay your monthly premium on time Present your ID card when you receive services. Make sure your provider has your current insurance information.
Stay in-network, if required by the plan Get prior authorization, if required by the plan What to do if your claim is retroactively denied: Cigna will notify you in writing about your appeal rights. Enrollee Recoupment of Overpayments How to get a refund if you paid too much for your insurance If you overpaid your insurance premium, you may qualify for a refund. Medical Necessity, Prior Authorization Timeframes, and Enrollee Responsibilities Do you need approval before a non-emergency hospital stay or having outpatient care?
Cigna reviews medical guidelines and your medical condition to make sure you have a medical need for services. To get approval, you or your provider must call us at least four business days Monday through Friday before you plan to have the procedure or service. Cigna will respond to your request within 10 calendar days if all information needed to make a decision is received. If the request is urgent, Cigna will respond within 72 hours.
You must get approval before your admission or treatment. If we find that the service was not medically necessary, you may have to pay for the services or it may result in a penalty. If you have already received the service, Cigna will respond to your request within 30 calendar days.
What is medical necessity? Get approval or prior authorization for: Inpatient admission. Approval is required for admission and continued stay in the hospital. Certain outpatient procedures and services To verify approval or prior authorization you can: Call Cigna at the number on the back of your ID card, or Check www. If you have an out-of-network provider, you must get approval. You can request approval for yourself or a family member.
Just call the Customer Service phone number on your ID card. Drug Exception Timeframes and Enrollee Responsibilities Covered prescription drugs Your health insurance plan has its own list of covered drugs, also called the Prescription Drug List.
Prior authorization for prescription drugs Some prescription drugs and related supplies may need prior authorization from Cigna.
Exceptions for prescription drugs not covered by your insurance plan Sometimes our members need access to drugs that are not listed on our drug list. How to complete the pharmacy form for a prior authorization or exception request: For a timely response to your prior authorization or exception request: Fill out a Prescription Drug Claim Form completely.
Write your Cigna ID number and the plan number on the claim form. Be sure that you are referencing your Cigna ID card. Learn more about appeals and grievances If you have questions about exceptions or prior authorizations, call Customer Service. Louis MO As part of your plan, we're at your service. You'll also find: An item-by-item breakdown of your health care visit with claim details page displayed in an easy-to-read format.
How much you have paid toward your plan deductible and out-of-pocket limits. A summary page with the amount saved and what you owe. Out-of-network dentists do not have a contract with Cigna at the time you receive services. Out-of-network dentists do not offer Cigna customers discounted fees.
Enrollee Claims Submission Enrollee claims submission After a visit with your dentist, they may send a bill to us.
Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. Each insurer has sole responsibility for its own products. Medicare Supplement policies contain exclusions, limitations, and terms under which the policies may be continued in force or discontinued. For costs and complete details of coverage, contact the company. This website is designed as a marketing aid and is not to be construed as a contract for insurance.
It provides a brief description of the important features of the policy. Please refer to the policy for the full terms and conditions of coverage. The benefits of this policy will not duplicate any benefits paid by Medicare. This policy will not pay benefits for the following:. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six 6 months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six 6 month waiting period has already been satisfied.
Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If You had less than six 6 months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. Selecting these links will take you away from Cigna.
What is Medicare Supplement? Find phone numbers for plan and coverage questions, claims mailing addresses, and more. Phone Number 24 hours a day, days a year. We encourage you to contact us directly if you need help with an existing plan.
Please review the plan types below and select the appropriate contact information. If you are in an Employer sponsored group plan, please call the phone number on the back of your ID card. Looking for a new Cigna Medicare Advantage Plan?
Call toll free:. For TTY service for hearing impaired callers, call for Telecommunications Relay Service and enter the toll free number you are calling. April 1 September Monday Friday am pm, Messaging service used weekends, after hours, and Federal holidays. Looking for information on your current Cigna Medicare Advantage Plan? Box Nashville, TN April 1 September Monday Friday am pm Arizona time. Voicemail available on weekends and Federal Holidays. Box Phoenix, AZ Our automated phone system may answer your call during weekends from April 1 September Box Weston, FL