Cigna Denied Your Emergency Room Visit?
Cigna Healthcare (The Cigna Group) denies 18.5% of claims on average. But 52% of appeals succeed when patients fight back. Your emergency room visit denial may have grounds for a successful appeal.
Why Cigna Denies Emergency Room Visit
Condition not a true emergency (retrospective review)
Out-of-network facility
Balance billing from ER physicians
Cigna's Common Denial Tactics
Mass auto-denials (300,000 claims in 2 months at 1.2 seconds each)
Requiring step therapy for medications your doctor already tried
Denying claims as "experimental" despite FDA approval
How to Win Your Emergency Room Visit Appeal
Document symptoms at time of visit (not diagnosis)
Cite prudent layperson standard — coverage based on symptoms, not final diagnosis
Invoke No Surprises Act for out-of-network emergency billing
Get ER physician documentation of presenting symptoms and urgency
Laws That Protect You
No Surprises Act — Out-of-network emergency protections
EMTALA — Emergency treatment requirement
Prudent layperson standard — Most states and ACA
Tips for Appealing to Cigna
Reference the ProPublica investigation into automated denials
Gather evidence of prior failed treatments to counter step therapy requirements
Obtain peer-reviewed studies supporting FDA-approved treatments
Ready to Fight Your Emergency Room Visit Denial?
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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.