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Behavioral Health Professionals

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Counseling & Therapy

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Terms & Definitions


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Employer ID:
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If I use my benefits, will I have a lot of paperwork?

If you go to an independent behavioral health professional within the Cigna Behavioral Health network, we handle all the paperwork and claims forms. If you opt for an out-of-network professional, and your benefits cover out-of-network services, you will most likely need to file a claim. With most plans, you will also be required to pay a larger portion of the costs yourself. Please consult your benefit plan summary for details. Call Cigna at the number on the back of your ID card to receive a claim form if you will be submitting claims for reimbursement.

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Where do I mail out-of-network claims?

Cigna Behavioral Health
P.O. Box 188022
Chattanooga, TN 37422

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What if I get a claim denial?

First, you must remain eligible in order for Cigna Behavioral Health to cover the service - even if coverage was pre-authorized for non-routine levels of care. When seeing an in-network contracted provider, claims are handled for you by your contracted behavioral health professional. On rare occasions, when services are not reimbursed, call Cigna at the number on the back of your ID card.

The most common factors for claim denial are:

  • Benefit authorization is not in place to cover the date when service was rendered. This suggests that you did not get pre-authorized coverage for the services you received. Pre-authorization of coverage is typically only required if you are not being seen 'outpatient' for a routine office visit with a Cigna Behavioral Health contracted provider.
  • Eligibility is not confirmed for the date when service was rendered. This suggests that your benefit plan was not in effect when the services were received.
  • Behavioral health professional is out-of-network. This suggests that you went to a professional who does not participate in the Cigna Behavioral Health network, and your benefits do not apply to out-of-network services. You may check the status of your behavioral health professional by calling the toll-free number on your insurance ID card.

If you are being billed by your behavioral health professional due to a claim denial, you may wish to speak directly with Cigna Behavioral Health to get more information about the denial.

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What if my medication isn't covered?

Cigna Behavioral Health does not administer the pharmacy benefits portion of your health benefit, but we will work with you to determine what the problem may be and who to call to try to get the situation fixed.

Most common explanations when a medication is not covered:

  • Behavioral health professional is out-of-network Your pharmacy benefits may not apply to prescriptions written by an out-of-network psychiatrist.
  • The prescribed medication is not on the formulary A formulary is the list of drugs covered by your pharmacy benefits. (Please note that not all plans use a formulary.) You may check to see whether your prescribed medication is on the formulary by calling your medical carrier's tool-free number (found on your insurance ID card) or checking their Web site. If it is not, you will want to discuss this with your psychiatrist. He/she will determine if an alternative medication on the formulary is appropriate for you. If one is not, your psychiatrist may submit a written appeal for exception to the company that handles your pharmacy benefits.

If you feel that a medication prescribed by your psychiatrist or nurse practitioner should be covered, please call us at the toll-free number on your insurance ID card, or call your medical carrier for immediate assistance.

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What do I do if I have questions about my claim?

In general, if you have a behavioral health claim question, you can call Cigna Behavioral Health Customer Service at the number on the back of your ID card. Not all claims for Mental Health/Substance Abuse are paid by Cigna Behavioral Health, however. Some accounts have a dedicated Customer Service/Claim line and you should dial that number for answers to your questions if your benefit plan is set up as such.

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