Where can I go to understand what mental health benefits I have for me and my family?
It is important to know exactly what your behavioral benefits are since they may be different than your medical benefits. In order to learn more about your specific behavioral health benefits, you can contact CIGNA Behavioral Health by calling the number listed on your insurance identification card. Our staff will help you to identify what is covered under your benefit plan and help you to access the appropriate referrals.
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 related to Autism:
- Speech Therapy -- This is not covered by CIGNA Behavioral Health. You may want to check with your medical carrier to see if they will cover it.
- Occupational Therapy -- This is not covered by CIGNA Behavioral Health. You may want to check with your medical carrier to see if they will cover it.
The following types of services are considered to be experimental treatments for Autism and would not be covered under your benefit plan:
- Biofeedback
- Hippotherapy
- Music Therapy
My state has a law regarding autism benefits. What is that?
Some states have passed laws designed to ensure that covered participants who are diagnosed with an autism diagnosis or a diagnosis on the Pervasive Developmental Disorder spectrum receive specific benefits or coverage. Your state may have a variation of this type of law with its own, unique list of covered services and benefits.
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.
Do autism treatment services need to be pre-authorized?
For routine outpatient office visits with an in-network provider, you do not need to contact us for pre-authorization. To find an in-network provider, call the number on the back of your ID card and ask for a list of providers with an autism specialty. In all other cases, and for all other types of service, including testing, you must contact us to pre-authorize your care to help rapid claim payment at the maximum in-network level. It is helpful to have the employee's social security number (found on the insurance identification card) when you call.
Be sure you understand the difference between in-network and out-of-network coverage. Seeing a professional who participates in CIGNA Behavioral Health's network means you'll pay less and have no paperwork. In addition, the professional will be licensed and meet CIGNA Behavioral Health's quality guidelines.
If you don't understand what is and isn't eligible for coverage by your plan, please contact us. We can help explain your coverage, deductibles and copays, and tell you how to access the kind of care you need. Also, read your benefit plan carefully for details of your eligible coverage.
When is psychological testing authorized?
Psychological testing is used as a diagnostic tool to help determine the focus of your care. Your doctor will need to contact CIGNA Behavioral Health to discuss his/her recommendation for psychological testing in order to establish medical necessity. Some types of psychological testing may not be covered by your benefit plan.
What does "medical necessity" mean?
CIGNA Behavioral Health will work with your provider to determine the appropriate level of care and duration of treatment that is necessary to decrease the symptoms that you are currently experiencing. You and your provider will develop a plan that will include specific behaviors/goals indicating that continuation of treatment is no longer necessary.
For further explanation of medical necessity, review our Level of Care Guidelines.
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