Cigna HealthCare of Arizona, Inc claim denials in Arizona: the federal figures
Cigna HealthCare of Arizona, Inc denied 13.2% of in-network claims in Arizona — 23,780 claims out of 180,629. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Cigna HealthCare of Arizona, Inc) | 26 | 46.2% |
| External review (independent) | — | — |
What Cigna HealthCare of Arizona, Inc denies most
The most common denial reason recorded for Cigna HealthCare of Arizona, Inc plans in Arizona is not medically necessary. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Not medically necessary | 9,228 | 34% |
| Provider out of network | 8,134 | 30% |
| Administrative reason | 5,713 | 21% |
| Other reasons | 3,522 | 13% |
| Referral required | 321 | 1.2% |
| Service excluded from the plan | 131 | 0.5% |
| Member not covered | 102 | 0.4% |
What to do if Cigna HealthCare of Arizona, Inc 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 HealthCare of Arizona, Inc overturned 46.2% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Cigna HealthCare of Arizona, Inc. 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 HealthCare of Arizona, Inc 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 HealthCare of Arizona, Inc's denial rate high?
13.2% against a national average of 16% across the plans in this dataset. It is at or below 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 HealthCare of Arizona, Inc ignore the external decision?
No. External review decisions are binding on the plan.