Cigna Denied Your Specialist Referral?
Cigna Healthcare (The Cigna Group) denies 18.5% of claims on average. But 52% of appeals succeed when patients fight back. Your specialist referral denial may have grounds for a successful appeal.
Why Cigna Denies Specialist Referral
Primary care can manage the condition
Out-of-network specialist not covered
Referral authorization expired or not obtained
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 Specialist Referral Appeal
PCP letter explaining why specialist care is needed
Documentation of failed primary care treatment
Evidence no in-network specialist is available for the condition
Laws That Protect You
ACA network adequacy requirements
State any-willing-provider laws
No Surprises Act for emergency specialist care
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 Specialist Referral 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.