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Behavioral Health Professionals

Getting Authorization

Counseling & Therapy

What's Covered

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Terms & Definitions


Your Employer ID is typically the commonly-known name of the company YOU WORK FOR, but without the spaces and in lowercase. Example: xyzcorporation
Employer ID:
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How do I make sure my services are covered or reimbursed?

Pre-authorization of benefit coverage is not required for outpatient routine office visits with a Cigna Behavioral Health contracted provider. Refer to your plan design, however, as for most other levels of care, you may need to call us for referral and benefit authorization first. We want to help ensure eligible services will be covered and claims handled for you by your contracted behavioral health professional. On rare occasions when services are not reimbursed, call us at the number on the back of your ID card. To make the most of your services, please consider these points:

  • If your plan has a benefit differential, be sure you understand the difference between in-network and out-of-network coverage. Seeing a behavioral health professional who participates in Cigna Behavioral Health's network may mean you'll pay less and have no paperwork.
  • If you don't understand what is and isn't covered by your plan, call us. We can help explain your eligible coverage, deductibles and copays, and tell you how to access the kind of care you need. In addition, read your benefit plan summary carefully.

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Is medication covered?

Cigna Behavioral Health does not administer the pharmacy benefits portion of your health plan, but we will work with you to determine whether any medication prescribed by your psychiatrist or nurse practitioner will be covered. Call us at the toll-free number on your insurance ID card.

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How can I get sessions covered that have already occurred?

Pre-authorization of benefit coverage is not required for routine, outpatient office visits. For all other levels of care, pre-authorization of coverage may be required, depending on your plan. Call the toll-free number on your insurance ID card if your plan does require pre-authorization of coverage for the level of care that you are seeking. If you do not obtain pre-authorization of coverage for services that require it, you may be responsible for some or all of the cost.

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What kinds of behavioral health services are covered?

Behavioral health services are available and covered for a variety of mental health and substance abuse problems. Your behavioral health professional will evaluate your needs and determine treatment. Cigna Behavioral Health care management staff will compare the recommended treatment to established Clinical Practice Guidelines and determine if benefits are available, in accordance with standard utilization review procedures.

People occasionally ask us about coverage for the following types of services:

Weight Loss – Weight loss services are not typically covered. However, services are covered under your behavioral health benefits for a mental health or substance abuse diagnosis for which weight loss may be a symptom.

Light Boxes – This is not covered by Cigna Behavioral Health. If this is prescribed by a medical doctor, you may want to check with your medical carrier to see if they will cover it.

Hypnotherapy ("Hypnosis") – Many behavioral health professionals use hypnotherapy as part of their treatment services. If the therapist you see uses hypnotherapy for the treatment of a covered disorder, it may be covered.

Aromatherapy – This type of treatment is considered to be an experimental treatment, so it would not be covered under your benefit plan.

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Is court-ordered treatment covered?

Not necessarily. Just because treatment is ordered by the court doesn't guarantee it will be covered under your particular benefit plan.

Like all mental health or substance abuse treatment, court-ordered treatment must meet medical necessity standards in order to be covered by your benefit plan. Call us at the toll-free number on your insurance ID card before your first visit to determine if the court-ordered behavioral health professional is covered. If your plan requires it, we will pre-authorize coverage for the assessment. After that initial visit, your behavioral health professional will make a recommendation and determine whether ongoing care is medically necessary.

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Are psychological tests covered?

It depends on your plan, the type of test, and medical necessity. Tests for learning disabilities and intelligence (IQ) tests are NOT covered. However, federal law requires public school districts to offer and perform such tests when they are necessary to determine whether your child is eligible for special education programs.

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Are smoking cessation programs or aids like nicotine patches covered?

Although smoking cessation programs and aids are rarely covered under medical plans and are NOT a covered service under Cigna Behavioral Health's EAP, there are many community resources that can help people who are trying to quit. You can find out more about local programs by calling your health care provider or the state or local health department. Information hotlines also provide quit-smoking materials and referrals:

The American Lung Association
1.800.LUNG.USA (1.800.586.4872)
www.lungusa.org

CancerNet: A service of the National Cancer Institute
1.800.4.CANCER (1.800.422.6237)
www.cancer.gov/cancerinfo/prevention-genetics-causes/prevention

The American Heart Association
1.800.AHA.USA1 (1.800.242.8721) www.women.americanheart.org/self_care/fs_smoking.html

To find out more about what benefits are available through your insurance plan, please call the toll-free number on your insurance ID card.

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My state has a law regarding biologically based benefits. What is that?

Some states have passed laws designed to ensure that covered participants who are diagnosed with a critical mental health condition receive the same level of benefits as the participant would expect to receive with a critical physical illness. These critical mental health conditions are most often referred to in state laws as "biologically-based" or "serious" mental illnesses. The law makers, using the same diagnostic references that mental health professionals use, typically define these biologically based mental illnesses as: schizophrenia; schizo-affective disorder; bi-polar disorder; major depressive disorder; panic disorder; paranoia, delusional and psychotic disorders; and obsessive-compulsive disorder. Some states, however, have expanded the list of “biologically based mental illnesses” to include other conditions such as anorexia-nervosa, bulimia and post-traumatic stress disorder. In a few unusual states, the list includes diagnoses related to alcohol and drug abuse. Your state may have a variation of this type of law with its own, unique list of covered mental illnesses whose benefit levels are mandated to be largely similar to the benefit levels for a physical condition.

Because mental illness conditions are diagnosed and treated differently than physical illnesses, the legislative interpretations of this concept, "mental illness benefit levels that are largely similar to those for physical conditions," varies significantly from state to state. Generally speaking, if you have a biologically based benefit law in your state that affects your health plan, you can expect that your plan's cost-sharing provisions (i.e., co-pays, co-insurance and deductibles) for biologically based mental conditions will mirror your plan's cost-sharing provisions for diagnosis and treatment of physical conditions. The intent of most states' laws is that you, as a covered participant, are not faced with a greater financial burden for your mental health care than you are for your physical health care.

To fully understand the terms and conditions of your mental health coverage, you should consult your plan's written description of mental health benefits or call the number on your ID card for a complete and precise description of how, and whether, the laws in your state affect the health plan provided to you by your employer or group.

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If I must cancel a scheduled appointment, do I still have to pay the copayment (or cancellation fee)?

Once you have established a business relationship with a Cigna Behavioral Health contracted behavioral health professional, you are only liable for charges (including deductibles, copayments/co-insurance) if you fail to give at least 24-hour notice of the cancellation.

It is best to notify your behavioral health professional well in advance of any need to cancel, as our contracted professionals have the right to charge you directly for any appointment missed without 24-hour cancellation notification.

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Do I have to pay the bill if the services are not covered?

We recommend that you always ask about services you are interested in to make sure they are covered under your specific plan. You can do this by calling the toll-free number on your insurance ID card. We also encourage you to read your benefit plan summary for details of your coverage as you will likely be liable for services that are not covered or ones that require pre-certification of coverage, where none was obtained.

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What do I do in the case of an emergency?

If you need emergency services please go to the nearest emergency room or behavioral health facility. We request that you or a representative call us as soon as possible, preferably within 48 hours, so that we can help you determine the benefits available to you under your plan. Your plan benefits will apply to services needed to evaluate or stabilize treatment for a condition that is reasonably considered to be an emergency behavioral health condition. Some plans may have a penalty if you do not call within a certain time frame after admission. Check with your plan if you are not sure what the requirements are.

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