Dealing with health insurance claims can be confusing and frustrating. When you need medical care, the last thing you want is a long, drawn-out claims process. So how long does it actually take Cigna to review and approve health insurance claims?
Overview of the Cigna Claims Process
Cigna is one of the largest health insurance providers in the U.S. When you receive medical care with Cigna insurance, your provider submits a claim to Cigna seeking reimbursement.
Here are the key steps in Cigna’s claims process:
Claim received – Cigna receives the claim from your provider, either electronically or by mail.
Claim processing – Cigna reviews the claim details according to your policy terms to determine approval/denial.
Request for information – If any information is missing from the claim, Cigna will request it from you or your provider.
Claim decision – Once all documentation is complete, Cigna will make a final claims decision.
Claim payment – If approved, Cigna will process payment to your provider.
Explanation of Benefits (EOB) – Cigna sends you an EOB outlining what was paid.
Member cost sharing – If you have coinsurance or a deductible, your provider bills you for the amount you owe.
The speed of this process depends on the completeness of the claim information submitted. Claims that are fully documented can be processed much faster.
Cigna’s Claims Processing Timeframes
Cigna sets internal targets for how long it should take to process clean claims where all information is provided upfront. Here are Cigna’s claims processing timeframes:
- Electronic claims – Processed within 15 calendar days from receipt of the claim
- Paper claims – Processed within 30 calendar days from receipt of the claim
However, Cigna notes these timeframes are targets only and not a guarantee. Processing times can vary.
Cigna also has expedited claims processing in urgent situations:
- Urgent care claims – Processed within 24 hours from receipt of the claim
- Emergency care claims – Processed within 1 calendar day from receipt of the claim
Urgent situations are those that could seriously impact your health if treatment is delayed.
Why Claims Processing Can Take Longer
While Cigna aims to process claims within 15-30 days, there are common reasons why claims may take longer:
Request for additional information – If Cigna finds the claim lacks required details, it can delay the process significantly. It may take weeks or months to obtain missing info from your provider.
Coordination of benefits – If you have coverage under more than one health plan, extra coordination steps add time.
Complex claims – Claims involving extensive services, high dollar amounts, or experimental treatments may require additional review.
Manual claims submission – Paper claims submitted by mail slow the process versus electronic submission.
Peak claim volumes – Cigna’s processing times may lengthen during high volume periods like open enrollment season.
Appeals – The appeal process for a denied claim can add weeks or months to the timeline.
Provider payment delays – Even after Cigna approves a claim, provider payment delays can prevent you from getting a bill right away.
Tips for Faster Cigna Claims Processing
You can help avoid claims processing delays by:
Confirming your provider has your complete, accurate insurance details before every visit
Asking your provider to submit claims electronically rather than by paper
Notifying Cigna if you have other insurance plans that need to coordinate benefits
Checking that your provider’s office has your current address and contact information
Following up if your provider is delayed in submitting claims after your visit
Sending any requested claim information back to Cigna promptly
Avoiding claims submission during Cigna’s busiest periods like open enrollment
Calling Cigna if a claim seems to be stalled for an extended period
What to Do If Your Claim is Delayed
If your Cigna claim is delayed longer than expected, stay proactive:
Track processing times – Note when you had services and when the claim was submitted to identify lag times.
Follow up – Contact your provider to ensure the claim was sent. Call Cigna to check claim status.
Watch for requests – Carefully review any requests from Cigna for more claim details and provide documents promptly.
Discuss timeline – Ask Cigna for an estimated processing completion date if delayed.
Escalate if urgent – For health emergencies, urgently appeal delays through Cigna’s expedited process.
Submit a complaint – For excessive delays without cause, submit a written complaint to Cigna about slow claims processing.
File an appeal – If you believe Cigna incorrectly denied your claim, submit a written appeal seeking reversal of the decision.
Get state assistance – As a last resort, contact your state’s department of insurance for help addressing claims delays.
Keeping an open line of communication with Cigna can help identify and resolve claims processing issues. Pay attention to appeal and complaint deadlines outlined in your denial letters or Explanation of Benefits.
How Long Does It Take to Get Claim Reimbursement from Cigna?
After Cigna processes the claim, how long does it take to receive claim reimbursement?
Once Cigna approves a claim and makes payment to your provider, the provider typically has around 30 days to issue your reimbursement or bill you for any member responsibility amounts.
However, provider reimbursement timing also varies case-by-case:
Faster reimbursement – Some providers issue reimbursements in as little as 1-2 weeks after Cigna’s payment.
Slower reimbursement – Other providers may take the full 30 days or occasionally longer during busy times.
Refund delays – Complex claims or payment investigations at the provider’s billing office can add time before a refund is issued.
So while Cigna aims to process clean claims within 15-30 days, actually receiving your claim refund can take 30 days or more depending on the provider.
Claim Denials and Total Timelines
What if Cigna denies your claim rather than approving reimbursement? Appealing a denial can add weeks or even months to the overall process.
Here are some examples of total timelines from date of services if a claim is denied:
Clean electronic claim – Between 15 days (initial processing) + 30 days (appeal) = 45 days or more
Delayed paper claim – Between 30 days (initial processing) + 60 days (appeal) = 90 days or more
Complex claim – Can take 45 days or longer for initial decision, then an appeal could extend the total timeline to 4-6 months
The bottom line is that while Cigna aims to process straightforward claims within 15-30 days, complex claims or appeals may stretch the full process to several months depending on circumstances. Maintaining open communication and staying on top of time-sensitive deadlines is key to expedite resolution.
How Cigna Claim Timelines Compare to Other Insurers
Cigna’s claims processing timeframes are similar to other major health insurers like UnitedHealthcare, Aetna, and Blue Cross Blue Shield plans.
- Strive to process electronic claims within 15-30 days
- Set a 30-day target for paper claims
- Have 1 day or 24 hour expedited claim procedures
- Require 30-60 days or more for appeals processes
However, actual claims data shows:
- Nationwide average claims processing time is 29 days
- 59% of claims are processed within 15 days or less
- 90% are processed within 45 days
So while Cigna’s timeframes reflect industry standards, most insurers exceed their 15-30 day targets fairly regularly. Careful follow up is important to keep claims moving efficiently.
Key Takeaways on Cigna Claim Timelines
The major points to remember on Cigna’s claims processing timeframes include:
- Fastest processing with electronic submission and complete documentation
- Targets 15 days for electronic claims but can vary
- Targets 30 days for paper claims but often takes longer
- Expedited claims in 1-24 hours for emergencies
- Appeals can add 30-60+ days if claims denied
- Similar to competitors but averages often longer than 15-30 days
- Reimbursement can take up to 30 days or more post-approval
Understanding Cigna’s process can help you set proper expectations. Check your Explanation of Benefits and follow up promptly on any delayed
Cigna Global Health Benefits: How to Submit a Claim and Get Reimbursement
How long does Cigna take to process a claim?
How long does Cigna take to approve insurance application?
Does Cigna deny a lot of claims?
How do I check the status of my Cigna claim?