Cigna Health and Life Insurance Company claim denials in Florida: the federal figures
Cigna Health and Life Insurance Company denied 19.5% of in-network claims in Florida — 611,580 claims out of 3,129,000. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Cigna Health and Life Insurance Company) | 960 | 22.6% |
| External review (independent) | 18 | — |
What Cigna Health and Life Insurance Company denies most
The most common denial reason recorded for Cigna Health and Life Insurance Company plans in Florida is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 238,885 | 36.9% |
| Administrative reason | 149,731 | 23.1% |
| Not medically necessary | 123,618 | 19.1% |
| Provider out of network | 118,712 | 18.3% |
| Service excluded from the plan | 6,910 | 1.1% |
| Referral required | 3,881 | 0.6% |
| Member not covered | 3,872 | 0.6% |
| Experimental or investigational | 831 | 0.1% |
| Benefit limit reached | 767 | 0.1% |
What to do if Cigna Health and Life Insurance Company denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Cigna Health and Life Insurance Company overturned 22.6% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Cigna Health and Life Insurance Company. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Cigna Health and Life Insurance Company appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Cigna Health and Life Insurance Company's denial rate high?
19.5% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Cigna Health and Life Insurance Company ignore the external decision?
No. External review decisions are binding on the plan.