Denied by Cigna or Evernorth across commercial, global, Medicare, or behavioral health plans? You have rights under ERISA and the ACA. ClaimBack writes your professional appeal letter in 3 minutes.
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Cigna serves 14 million members across commercial, global, and Medicare plans. Its Evernorth division covers behavioral health. Federal and state law give you strong appeal rights.
Cigna commercial plans are regulated by your State Department of Insurance (DOI). For employer-sponsored ERISA plans, the Department of Labor (DOL) has oversight authority. The DOL's Employee Benefits Security Administration (EBSA) enforces ERISA rights and can investigate Cigna for violations. You can file a complaint with either body if Cigna fails to follow proper procedures.
Cigna operates a two-level internal appeal process before external review. Level 1 is reviewed by a different clinical team than the one that made the original decision. Level 2 escalates to senior medical reviewers. After exhausting both internal levels, you have the right to independent external review. For Evernorth behavioral health denials, specific mental health parity rules apply under the Mental Health Parity and Addiction Equity Act.
Cigna must acknowledge your appeal within 5 business days. Level 1 internal decisions are due within 30 days for pre-service and 60 days for post-service claims. Urgent/expedited appeals must be decided within 72 hours. Following internal appeal exhaustion, external review decisions are issued within 45 days (standard) or 72 hours (urgent). Cigna is legally required to meet these deadlines.
Consumer advocacy data shows that 50–70% of Cigna appeals that include complete medical documentation and a properly argued letter succeed in overturning the denial. Behavioral health and mental health parity claims in particular have seen high success rates in recent enforcement actions. The most common reason appeals fail is missing clinical evidence — ClaimBack helps you get it right the first time.
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ClaimBack provides AI-assisted document drafting. We are not a law firm and do not provide legal advice.