Complete Guide to Cigna's Appeals Process: 3 Levels Explained
Learn how to navigate Cigna's three-level internal appeal process, request external IRO review, use myCigna.com, and contact Cigna's appeals department in Chattanooga, TN.
Complete Guide to Cigna's Appeals Process: 3 Levels Explained
Cigna is the fourth-largest health insurer in the United States, covering approximately 20 million members through commercial plans, Medicare Advantage, and international expatriate coverage. When Cigna denies a claim, you have legally protected rights to appeal through multiple levels of review. This guide explains the complete Cigna appeals process — from Level 1 internal appeal through external independent review — including specific contacts, timelines, and documentation requirements.
Understanding Your Cigna Denial
Every Cigna denial triggers a specific set of rights. Before beginning your appeal, confirm:
What type of denial did you receive?
- Pre-service denial: Cigna denied Prior Authorization Denied: How to Appeal" class="auto-link">prior authorization before care was received
- Concurrent denial: Cigna denied continued coverage during ongoing treatment
- Post-service denial: Cigna denied payment after care was already delivered
- Pharmacy denial: Express Scripts/Evernorth denied a prescription claim
What was the stated reason?
- Not medically necessary
- Non-covered service or exclusion
- Out-of-network provider without exception
- Prior authorization not obtained
- Experimental or investigational treatment
The denial reason determines your appeal strategy. A medical necessity denial requires clinical evidence; a coverage exclusion may require a plan document analysis or mandate compliance argument.
Level 1: Internal Appeal
Timeframe to File
You have 180 days from the date of the denial to file a Level 1 internal appeal with Cigna. Missing this deadline typically forfeits your appeal rights, so acting promptly is critical.
How to File
By mail (recommended for documentation purposes): Cigna Attn: Appeals PO Box 188011 Chattanooga, TN 37422
Send via certified mail with return receipt to create a paper trail.
By phone: 1-800-88-CIGNA (1-800-882-4462) Available Monday–Friday, 8 AM–8 PM local time
Online: Through myCigna.com — log in, navigate to "Claims," select the denied claim, and look for the "Appeal" option. The portal allows document upload and provides claim status tracking.
By fax: Fax numbers for Cigna appeals vary by plan type. The specific fax number for your plan is listed on your denial letter or obtainable by calling 1-800-88-CIGNA.
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What to Include in Your Level 1 Appeal
- A cover letter stating the claim number, date of service, and reason you believe the denial was incorrect
- A copy of the denial letter or EOB
- A letter of medical necessity from your treating physician
- Relevant medical records supporting your case
- Clinical guidelines or peer-reviewed literature if Cigna's criteria conflict with accepted medical standards
- Any additional documentation addressing the specific denial reason
Cigna's Response Timeline
- Standard reviews: Cigna must decide within 30 days for pre-service appeals, 60 days for post-service appeals
- Urgent/expedited reviews: Cigna must decide within 72 hours
- Concurrent care appeals: Expedited review is available; Cigna must respond before the current authorized period ends
eviCore and Peer-to-Peer Review
For prior authorization denials in radiology, physical therapy, spine surgery, sleep medicine, and cardiology — categories managed through Cigna's clinical subsidiary eviCore healthcare — your treating physician can request a peer-to-peer review with an eviCore medical director before or during the appeal process.
Peer-to-peer reviews are not appeals — they are clinical discussions that often resolve PA denials without formal written appeals. Request a peer-to-peer by calling 1-800-88-CIGNA (1-800-882-4462) and asking to be connected to the eviCore review line for the relevant specialty.
Level 2: Second-Level Internal Appeal
Not all Cigna plans offer a second-level internal appeal. Check your Summary Plan Description or denial letter to confirm whether Level 2 is available for your plan type.
If available, Level 2 is an additional internal review conducted by Cigna clinical staff who were not involved in the Level 1 decision. The process mirrors Level 1:
- File within the timeframe specified in your Level 1 appeal determination (often 60 days)
- Submit any additional evidence that was not available for Level 1
- Address specific arguments made in the Level 1 denial letter
iro">External Independent Review (IRO)
After exhausting internal appeals (Level 1 and Level 2 if available), you have the right to an external independent review by an organization independent of Cigna.
How External Review Works
- An Independent Review Organization (IRO) certified by your state or the federal government reviews your case
- IRO reviewers are clinical specialists with expertise in the medical area at issue
- The IRO's decision is binding on Cigna — if the IRO overturns the denial, Cigna must cover the service
- External review is available at no cost to you
How to Request External Review
- Request external review through Cigna at 1-800-88-CIGNA or via the written address above
- Cigna must provide you with external review information in its final internal appeal determination
- For state-regulated (fully insured) plans: the IRO process is administered by your state's Department of Insurance
- For ERISA self-funded plans: the federal external review process applies
External Review Timelines
- Standard external review: 60 days from request
- Expedited external review: 72 hours for urgent situations
Special Situations
For Medicare Advantage (MA) Cigna plans: The appeals process differs significantly. MA plan appeals go through Cigna's MA organization, then the Qualified Independent Contractor (QIC), then the Office of Medicare Hearings and Appeals (OMHA), then the Medicare Appeals Council, and finally federal district court.
For ERISA employer plans: After all internal and external remedies are exhausted, ERISA members may file a lawsuit in federal district court under ERISA Section 502(a). The DOL's Employee Benefits Security Administration (EBSA) at 1-866-444-3272 can also assist with ERISA plan compliance issues.
For Express Scripts pharmacy denials: Pharmacy appeals are handled through the Express Scripts/Evernorth pharmacy benefit system. Call the number on your prescription card, or initiate through myCigna.com under the pharmacy section.
Using myCigna.com for Appeals
The myCigna.com member portal provides:
- Real-time claim status for pending claims and appeals
- Document upload capability for appeal submissions
- Explanation of Benefits (EOB) access
- Live chat and secure messaging with Cigna representatives
- Appeal initiation for many claim types
Register at myCigna.com using your member ID from your Cigna insurance card.
Fight Back With ClaimBack
Navigating Cigna's multi-level appeal process is complex, but you do not have to do it alone. ClaimBack helps you identify the right appeal type, draft a complete and compelling appeal submission, and track your case through each level of the Cigna appeals system.
Start your Cigna appeal at ClaimBack
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