Cigna HealthCare of Illinois, Inc. claim denials in Illinois: the federal figures
Cigna HealthCare of Illinois, Inc. denied 24.3% of in-network claims in Illinois — 97,334 claims out of 400,177. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Cigna HealthCare of Illinois, Inc.) | 64 | 40.6% |
| External review (independent) | — | — |
What Cigna HealthCare of Illinois, Inc. denies most
The most common denial reason recorded for Cigna HealthCare of Illinois, Inc. plans in Illinois is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 26,668 | 37% |
| Not medically necessary | 18,789 | 26% |
| Provider out of network | 12,940 | 17.9% |
| Other reasons | 12,855 | 17.8% |
| Service excluded from the plan | 319 | 0.4% |
| Referral required | 306 | 0.4% |
| Member not covered | 227 | 0.3% |
| Experimental or investigational | 48 | 0.1% |
What to do if Cigna HealthCare of Illinois, 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 Illinois, Inc. overturned 40.6% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Cigna HealthCare of Illinois, 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 Illinois, 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 Illinois, Inc.'s denial rate high?
24.3% 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 Illinois, Inc. ignore the external decision?
No. External review decisions are binding on the plan.