Cigna HealthCare of Georgia, Inc. claim denials in Georgia: the federal figures
Cigna HealthCare of Georgia, Inc. denied 17.7% of in-network claims in Georgia — 144,773 claims out of 819,128. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Cigna HealthCare of Georgia, Inc.) | — | — |
| External review (independent) | — | — |
What Cigna HealthCare of Georgia, Inc. denies most
The most common denial reason recorded for Cigna HealthCare of Georgia, Inc. plans in Georgia is provider out of network. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Provider out of network | 61,489 | 33.8% |
| Other reasons | 44,021 | 24.2% |
| Not medically necessary | 34,332 | 18.9% |
| Administrative reason | 33,864 | 18.6% |
| Service excluded from the plan | 5,878 | 3.2% |
| Referral required | 1,353 | 0.7% |
| Member not covered | 779 | 0.4% |
| Benefit limit reached | 27 | 0% |
What to do if Cigna HealthCare of Georgia, 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.
- If they say no again, go external. An independent organization reviews it — not Cigna HealthCare of Georgia, 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 Georgia, 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 Georgia, Inc.'s denial rate high?
17.7% 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 HealthCare of Georgia, Inc. ignore the external decision?
No. External review decisions are binding on the plan.