Cigna Claim Form

If you go to a healthcare provider within Cigna’s network, the provider and Cigna will handle all of the paperwork involved. But if you use an out-of-network provider and your benefits cover this type of service, you will likely have to file a Cigna claim form.

Before seeing an out-of-network provider, consult your benefit plan to determine whether Cigna will pay part or all of the costs. You can also call Cigna’s Treatment Approval Team, who will help find the best provider and arrange to pay them directly so you won’t have to deal with paperwork. In addition to out-of-network services, you may need to file a claim if your doctor bills you directly for indemnification.

Claim Instructions

After deciding whether you need to file a claim form, download a claim form and fill it out according to the instructions on page 2. Then mail the completed forms and a bill itemizing the services to the address on your Cigna Membership card. Be sure to submit the form within 12 months of the services you received.

Mailing Address

Mail out-of-network claims to:

Cigna Behavioral Health
P.O. Box 188022
Chattanooga, TN 37422

Within approximately four weeks, you will receive an Explanation of Benefits, which summarizes the charges and reimbursement for your claim. This document lets customers see the total costs of the services, the customer’s discount, what Cigna paid for, what the customer is responsible for paying for, and why.

Filling Out the Form

The form requires detailed personal information and information related to your services. The form can be used for all Cigna plans, but you have to obtain a separate form for dental or pharmacy services. Some claim forms may be filled in electronically, but you may also print them and complete them with black ink.

You must include your member ID number located on your Cigna card for the form to be processed. You must also write in your DOB, name, address, phone number, and your employer’s name, and you must include patient information if the claim is for a relative, spouse, or child who’s not the beneficiary of the insurance. You will fill out a similar section if the patient who received the services is your dependent. Then you must state whether the services were required because of work-related injury/illness or auto accident, and describe the ailment and the date it occurred.

Finally, you have to attach an itemized bill detailing the services with the following information:

• Date of services
• Patient and employee names
• Address and name of location where each service was received
• Doctor’s names and tax ID numbers
• Description of each service
• Costs of each service
• Diagnoses made