Frequently Asked Questions
Who is eligible to join?
How do I find a Plan participating provider?
Do I need a referral to see a specialist?
How do I submit a claim?
Click here to download a Medical Claim Form. In most cases, providers and facilities file claims for you. Your physician must file on the form CMS-1500; your facility will file on the UB-04 form. Claims should be itemized and show:
- Name of patient and relationship to enrollee;
- Plan identification number of the enrollee;
- Name and address of person or firm providing the service or supply;
- Date that services or supplies were furnished;
- Type of each service or supply; and
- The charge for each service or supply.
Note: Canceled checks, cash register receipts, or balance due statements are not acceptable substitutes for itemized bills.
You must send a copy of the explanation of benefits (EOB) form you received from any primary payer with your claim.
Bills for rental or purchase of durable medical equipment and private duty nursing require a written statement from the physician specifying the medical necessity for the service or supply and the length of time needed.
Mail all medical claims to:
Cigna Payor 62308
P. O. Box 188007
Chattanooga, TN 37422
Mail all correspondence to:
11301 Old Georgetown Rd.
Rockville, MD 20852-2800
How can I find the status of a submitted claim?
There are several options:
- Click here to access the My Claim History link.
- Click here to send a secure e-mail with your status inquiry.
- Call Member Services at 1-800-638-6589, between the hours of 8:00 am and 5:00 pm, Eastern Time, Monday-Friday.
If you are a Health Care Professional, click here to access the WebConnect portal offered through our partnership with Change Healthcare.
What services require precertification or prior authorization?
The Plan requires precertification for:
Inpatient hospital stays:
You, your representative, your doctor, or your hospital must call Cigna/CareAllies at 1-800-887-9735 for hospital precertification. Precertify scheduled admissions 7 days (whenever possible) before admission. Emergency admissions must be certified within 48 hours of the admission, even if you have already been discharged.
Note: We will reduce our benefits for the inpatient hospital stay by $500 if precertification is not obtained.
Surgical treatment of morbid obesity (bariatric surgery):
Contact Cigna/CareAllies at 1-800-887-9735.
Before your initial evaluation as a potential candidate for a transplant procedure, you or your doctor must contact the CareAllies Cigna Lifesource Transplant Unit at 1-800-668-9682.
Durable Medical Equipment, Home Infusion Therapy, Home Nursing Care, Speech Therapy, Unlisted Outpatient Procedures, Certain Musculoskeletal Procedures, Certain Outpatient Procedures and Outpatient Spinal Procedures.
Call Cigna/CareAllies at 1-800-887-9735.
Services for Genetic Testing:
Call SAMBA at 1-800-638-6589 or 301-984-1440 (for TDD, use 301-984-4155).
Intensive Outpatient Program Treatment, Partial Hospitalization, Electroconvulsive Therapy, and Extended Outpatient Visits for Mental Health or Substance Misuse Treatment:
Contact Cigna/CareAllies at 1-800-887-9735.
Gender Reassignment Surgery to Treat Gender Dysphoria Supported by a Qualified Mental Health Professional:
You, your representative, your doctor or facility must call Cigna/CareAllies at 1-800-887-9735 prior to services being rendered.
Certain classes of drugs including, but not limited to, Growth Hormone Therapy (GHT) drugs. Call Express Scripts at 1-855-315-8527 for additional information and preauthorization.
The following Radiology/Imaging procedures:
- CT/CAT scan – Computed Tomography/Computerized Axial Tomography
- MRA – Magnetic Resonance Angiography
- MRI – Magnetic Resonance Imaging
- NC – Nuclear Cardiology
- PET – Positron Emission Tomography
You or your doctor must contact Cigna/CareAllies at 1-800/887-9735 before scheduling the procedure.
Does maternity care require precertification?
What preventative services are covered?
The following Preventive Services are covered (see the official Plan brochure for a complete listing):
Adult Preventive Care:
- One routine physical exam per year, including certain lab tests and screenings
- One annual routine gynecological visit for women age 18 or over
- Routine screenings, such as:
- Fecal occult blood test for members age 40 and older
- Pap smear – Cervical cancer
- Double contrast barium enema every 5 years starting at age 50
- Total blood cholesterol
- Chlamydial infections
- Routine Prostate Specific Antigen (PSA) test
- Osteoporosis screenings, for women age 60 and older
- Sigmoidoscopy screening – every 5 years starting at age 50
- Colonoscopy – every 10 years starting at age 50
- Adult routine immunizations endorsed by the Centers for Disease Control and Prevention (CDC)
- Routine mammograms (PPO payable at 100% no deductible) according to the age ranges below:
- From age 35 to 39 – one during this 5 year period.
- From age 40 and older – one every calendar year.
Children Preventive Care:
- Childhood immunizations recommended by the American Academy of Pediatrics
- Office visits for well child care examinations (up to age 18)
What is our protection against catastrophic cost (out-of-pocket maximum)?
Am I covered when I travel out of state or overseas?
How much do I pay for prescription drugs?
What is the prescription drug formulary?
The formulary identifies preferred name brand drugs that help contain your costs. Your copayment is less for drugs listed on the formulary. Click here to view the formulary list; Prescription Formulary Guide.