{"id":"cigna","page":"https://escalate.alexgaoth.com/#/c/cigna","html":"https://escalate.alexgaoth.com/c/cigna/","generated":"2026-10-15","company":{"id":"cigna","name":"Cigna Healthcare","aliases":["cigna","cigna health","the cigna group","mycigna","evernorth"],"sector":"insurance_health","parent":"The Cigna Group","website":"https://www.cigna.com","account_url":"https://my.cigna.com/web/public/guest","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claims-coverage-phone","type":"phone","label":"Medical, dental and vision coverage and claims","value":"+1-800-244-6224","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"behavioral-health-phone","type":"phone","label":"Behavioral health benefits","value":"+1-800-433-5768","hours":"24/7/365","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"tty","type":"phone","label":"TTY/TDD relay","value":"711","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Live chat in myCigna (certain products only)","value":"https://my.cigna.com/web/secure/consumer/contact-us","hours":"Mon-Fri 9 am-8 pm ET","access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"File a claim, view claims and EOBs (myCigna)","value":"https://my.cigna.com/web/public/guest","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claims-mail","type":"mail","label":"Medical claims (member-submitted)","value":"Cigna Healthcare, PO Box 182223, Chattanooga, TN 37422-7223","purposes":["claim_delay"],"notes":"Use the medical claim form. Dental claims go to PO Box 188037, Chattanooga, TN 37422-7223.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"},{"id":"forms-page","type":"web_form","label":"Customer forms (appeals, external review, appointment of representative, claim forms)","value":"https://www.cigna.com/individuals-families/member-guide/customer-forms","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"},{"id":"authorized-rep-form","type":"web_form","label":"Appointment of representative form (printable)","value":"https://www.cigna.com/static/www-cigna-com/docs/cigna-healthcare-appointment-of-representative-printable.pdf","purposes":["claim_denial"],"source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","channel":"member-services-phone","note":"Use the number on the back of the member ID card."},{"rung":"written_complaint","channel":"appeal-form","note":"Internal appeal or grievance, sent to the address on the denial letter."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for fully insured plans; complaint to the state."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Call customer service, then file a written appeal with the medical appeal form, then ask for external review.","evidence":["denial letter or EOB","member ID card","medical records","provider letter of medical necessity"],"steps":[{"do":"Call customer service. Ask for the reason, the plan provision and how to appeal. Cigna says it tries to resolve complaints on the first contact.","channel":"member-services-phone"},{"do":"If someone else will appeal for you, complete the appointment of representative form.","channel":"authorized-rep-form"},{"do":"Complete the medical appeal request form and send it with records to the address on the denial letter, within the deadline on that letter.","channel":"appeal-form"},{"do":"After the final internal denial, use the external review forms on the forms page (state forms apply in some states), or contact your state insurance department.","channel":"forms-page"},{"do":"For an employer self-funded plan, contact the Department of Labor if the plan does not follow the claims rules.","regulator":"dol-ebsa"}],"facts":[{"kind":"policy","claim":"Cigna's member rights page says Cigna will hear and act on complaints and appeals, guide members through the grievance process if they disagree with a decision, and provide language interpretation and TTY services for complaint and appeal processes.","issues":["claim_denial"],"source":"https://www.cigna.com/legal/members/member-rights-and-responsibilities","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Compare the bill with the EOB in myCigna, then ask customer service and the provider to fix it.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB in myCigna.","channel":"claim-status"},{"do":"Call the claims line about a claim processed wrongly. Ask the provider to rebill to the EOB amount.","channel":"claims-coverage-phone"},{"do":"If it is not fixed, file an appeal with the medical appeal form.","channel":"appeal-form"}]},{"issue":"surprise_medical_bill","summary":"Check the bill against the EOB, tell Cigna and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":"claim-status"},{"do":"Tell Cigna customer service and the provider that the bill may be a surprise bill.","channel":"member-services-phone"},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}]}],"known_blockers":["Claims, EOBs and chat need a myCigna login.","Appeal and external review forms do not show one national address; use the address on the denial letter.","Some external review forms on the forms page are state-specific."],"notes":"Cigna Healthcare is part of The Cigna Group. Behavioral health appeals use Evernorth-branded forms. The plan type (fully insured or employer self-funded) decides whether state external review or federal ERISA rules apply.","official_domains":["cigna.com","evernorth.com"],"security":{"known_scams":[{"kind":"policy","claim":"Promotions offer free tests, treatment or services and ask for insurance information. Cigna says to be wary of them and careful about disclosing insurance information.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"Fraudsters file claims for services never received, forge or alter bills, or use another person's coverage or insurance card. Check each explanation of benefits.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"special-investigations-phone","type":"phone","label":"Cigna Healthcare Special Investigations hotline (report fraud)","value":"+1-800-667-7145","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-email","type":"email","label":"Cigna Healthcare Special Investigations (report fraud)","value":"specialInvestigations@evernorth.com","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-mail","type":"mail","label":"Cigna Healthcare Special Investigations (report fraud by mail)","value":"Cigna Healthcare Special Investigations, 900 Cottage Grove Road W3SIU, Hartford, CT 06152","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}]}},"playbooks":{"claim_denial":{"company":{"id":"cigna","name":"Cigna Healthcare","sector":"insurance_health","website":"https://www.cigna.com","account_url":"https://my.cigna.com/web/public/guest"},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Call customer service, then file a written appeal with the medical appeal form, then ask for external review.","evidence":["denial letter or EOB","member ID card","medical records","provider letter of medical necessity"],"steps":[{"do":"Call customer service. Ask for the reason, the plan provision and how to appeal. Cigna says it tries to resolve complaints on the first contact.","channel":{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"do":"If someone else will appeal for you, complete the appointment of representative form.","channel":{"id":"authorized-rep-form","type":"web_form","label":"Appointment of representative form (printable)","value":"https://www.cigna.com/static/www-cigna-com/docs/cigna-healthcare-appointment-of-representative-printable.pdf","purposes":["claim_denial"],"source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"do":"Complete the medical appeal request form and send it with records to the address on the denial letter, within the deadline on that letter.","channel":{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"do":"After the final internal denial, use the external review forms on the forms page (state forms apply in some states), or contact your state insurance department.","channel":{"id":"forms-page","type":"web_form","label":"Customer forms (appeals, external review, appointment of representative, claim forms)","value":"https://www.cigna.com/individuals-families/member-guide/customer-forms","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"do":"For an employer self-funded plan, contact the Department of Labor if the plan does not follow the claims rules.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claims-coverage-phone","type":"phone","label":"Medical, dental and vision coverage and claims","value":"+1-800-244-6224","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"behavioral-health-phone","type":"phone","label":"Behavioral health benefits","value":"+1-800-433-5768","hours":"24/7/365","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"tty","type":"phone","label":"TTY/TDD relay","value":"711","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Live chat in myCigna (certain products only)","value":"https://my.cigna.com/web/secure/consumer/contact-us","hours":"Mon-Fri 9 am-8 pm ET","access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"File a claim, view claims and EOBs (myCigna)","value":"https://my.cigna.com/web/public/guest","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"},{"id":"forms-page","type":"web_form","label":"Customer forms (appeals, external review, appointment of representative, claim forms)","value":"https://www.cigna.com/individuals-families/member-guide/customer-forms","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"},{"id":"authorized-rep-form","type":"web_form","label":"Appointment of representative form (printable)","value":"https://www.cigna.com/static/www-cigna-com/docs/cigna-healthcare-appointment-of-representative-printable.pdf","purposes":["claim_denial"],"source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}],"facts":[{"kind":"policy","claim":"Cigna's member rights page says Cigna will hear and act on complaints and appeals, guide members through the grievance process if they disagree with a decision, and provide language interpretation and TTY services for complaint and appeal processes.","issues":["claim_denial"],"source":"https://www.cigna.com/legal/members/member-rights-and-responsibilities","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.","source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For urgent care claims, a group health plan must decide an appeal \"not later than 72 hours after receipt of the claimant's request for review\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"An external review must be requested within \"4 months after the date you receive a notice or final determination\" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to strictly follow the internal claims and appeals requirements, the claimant \"is deemed to have exhausted the internal claims and appeals process\", subject to a de minimis exception.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.","source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"Group health plan initial decisions: urgent care claims \"not later than 72 hours after receipt of the claim by the plan\"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims \"not later than 30 days after receipt of the claim\", with one extension of up to 15 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Disability claims: notice of decision \"not later than 45 days after receipt of the claim by the plan\", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have \"at least 60 days following receipt of a notification\" of the adverse determination.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to establish or follow these claims procedures, \"a claimant shall be deemed to have exhausted the administrative remedies available under the plan\" and may bring a civil action under ERISA section 502(a).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance, sent to the address on the denial letter.","channel":{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Claims, EOBs and chat need a myCigna login.","Appeal and external review forms do not show one national address; use the address on the denial letter.","Some external review forms on the forms page are state-specific."],"security":{"official_domains":["cigna.com","evernorth.com"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"Promotions offer free tests, treatment or services and ask for insurance information. Cigna says to be wary of them and careful about disclosing insurance information.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"Fraudsters file claims for services never received, forge or alter bills, or use another person's coverage or insurance card. Check each explanation of benefits.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"special-investigations-phone","type":"phone","label":"Cigna Healthcare Special Investigations hotline (report fraud)","value":"+1-800-667-7145","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-email","type":"email","label":"Cigna Healthcare Special Investigations (report fraud)","value":"specialInvestigations@evernorth.com","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-mail","type":"mail","label":"Cigna Healthcare Special Investigations (report fraud by mail)","value":"Cigna Healthcare Special Investigations, 900 Cottage Grove Road W3SIU, Hartford, CT 06152","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.968,"sources":{"primary":30,"other":1},"verified_from":{"page":16},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 97% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Cigna Healthcare is part of The Cigna Group. Behavioral health appeals use Evernorth-branded forms. The plan type (fully insured or employer self-funded) decides whether state external review or federal ERISA rules apply.","warnings":[]},"billing_error":{"company":{"id":"cigna","name":"Cigna Healthcare","sector":"insurance_health","website":"https://www.cigna.com","account_url":"https://my.cigna.com/web/public/guest"},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Compare the bill with the EOB in myCigna, then ask customer service and the provider to fix it.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB in myCigna.","channel":{"id":"claim-status","type":"portal","label":"File a claim, view claims and EOBs (myCigna)","value":"https://my.cigna.com/web/public/guest","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"do":"Call the claims line about a claim processed wrongly. Ask the provider to rebill to the EOB amount.","channel":{"id":"claims-coverage-phone","type":"phone","label":"Medical, dental and vision coverage and claims","value":"+1-800-244-6224","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"do":"If it is not fixed, file an appeal with the medical appeal form.","channel":{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claims-coverage-phone","type":"phone","label":"Medical, dental and vision coverage and claims","value":"+1-800-244-6224","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"behavioral-health-phone","type":"phone","label":"Behavioral health benefits","value":"+1-800-433-5768","hours":"24/7/365","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"tty","type":"phone","label":"TTY/TDD relay","value":"711","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Live chat in myCigna (certain products only)","value":"https://my.cigna.com/web/secure/consumer/contact-us","hours":"Mon-Fri 9 am-8 pm ET","access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"File a claim, view claims and EOBs (myCigna)","value":"https://my.cigna.com/web/public/guest","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}],"facts":[],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.","source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"The seller must obtain \"a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance, sent to the address on the denial letter.","channel":{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Claims, EOBs and chat need a myCigna login.","Appeal and external review forms do not show one national address; use the address on the denial letter.","Some external review forms on the forms page are state-specific."],"security":{"official_domains":["cigna.com","evernorth.com"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"Promotions offer free tests, treatment or services and ask for insurance information. Cigna says to be wary of them and careful about disclosing insurance information.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"Fraudsters file claims for services never received, forge or alter bills, or use another person's coverage or insurance card. Check each explanation of benefits.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"special-investigations-phone","type":"phone","label":"Cigna Healthcare Special Investigations hotline (report fraud)","value":"+1-800-667-7145","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-email","type":"email","label":"Cigna Healthcare Special Investigations (report fraud)","value":"specialInvestigations@evernorth.com","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-mail","type":"mail","label":"Cigna Healthcare Special Investigations (report fraud by mail)","value":"Cigna Healthcare Special Investigations, 900 Cottage Grove Road W3SIU, Hartford, CT 06152","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.968,"sources":{"primary":30,"other":1},"verified_from":{"page":16},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 97% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Cigna Healthcare is part of The Cigna Group. Behavioral health appeals use Evernorth-branded forms. The plan type (fully insured or employer self-funded) decides whether state external review or federal ERISA rules apply.","warnings":[]},"surprise_medical_bill":{"company":{"id":"cigna","name":"Cigna Healthcare","sector":"insurance_health","website":"https://www.cigna.com","account_url":"https://my.cigna.com/web/public/guest"},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"Check the bill against the EOB, tell Cigna and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":{"id":"claim-status","type":"portal","label":"File a claim, view claims and EOBs (myCigna)","value":"https://my.cigna.com/web/public/guest","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"do":"Tell Cigna customer service and the provider that the bill may be a surprise bill.","channel":{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"behavioral-health-phone","type":"phone","label":"Behavioral health benefits","value":"+1-800-433-5768","hours":"24/7/365","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"tty","type":"phone","label":"TTY/TDD relay","value":"711","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"},{"id":"chat","type":"chat","label":"Live chat in myCigna (certain products only)","value":"https://my.cigna.com/web/secure/consumer/contact-us","hours":"Mon-Fri 9 am-8 pm ET","access":"login","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}],"facts":[],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance, sent to the address on the denial letter.","channel":{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Claims, EOBs and chat need a myCigna login.","Appeal and external review forms do not show one national address; use the address on the denial letter.","Some external review forms on the forms page are state-specific."],"security":{"official_domains":["cigna.com","evernorth.com"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"Promotions offer free tests, treatment or services and ask for insurance information. Cigna says to be wary of them and careful about disclosing insurance information.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"Fraudsters file claims for services never received, forge or alter bills, or use another person's coverage or insurance card. Check each explanation of benefits.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"special-investigations-phone","type":"phone","label":"Cigna Healthcare Special Investigations hotline (report fraud)","value":"+1-800-667-7145","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-email","type":"email","label":"Cigna Healthcare Special Investigations (report fraud)","value":"specialInvestigations@evernorth.com","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-mail","type":"mail","label":"Cigna Healthcare Special Investigations (report fraud by mail)","value":"Cigna Healthcare Special Investigations, 900 Cottage Grove Road W3SIU, Hartford, CT 06152","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.968,"sources":{"primary":30,"other":1},"verified_from":{"page":16},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 97% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Cigna Healthcare is part of The Cigna Group. Behavioral health appeals use Evernorth-branded forms. The plan type (fully insured or employer self-funded) decides whether state external review or federal ERISA rules apply.","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"Use the number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Cigna Healthcare customer service","value":"+1-800-997-1654","hours":"24/7/365","purposes":["claim_denial","claim_delay","billing_error","poor_service","surprise_medical_bill"],"notes":"Cigna also tells members to call the toll-free number on the ID card. TTY users dial 711.","source":"https://www.cigna.com/contact-us/","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance, sent to the address on the denial letter.","channel":{"id":"appeal-form","type":"web_form","label":"Medical appeal request form (printable PDF)","value":"https://www.cigna.com/static/www-cigna-com/docs/medical-appeal-request.pdf","purposes":["claim_denial"],"notes":"Send it to the address on the denial letter or EOB. Behavioral health appeals use the Evernorth behavioral appeal form on the same forms page.","source":"https://www.cigna.com/individuals-families/member-guide/customer-forms","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["cigna.com","evernorth.com"],"never_asks":[],"known_scams":[{"kind":"policy","claim":"Promotions offer free tests, treatment or services and ask for insurance information. Cigna says to be wary of them and careful about disclosing insurance information.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"kind":"policy","claim":"Fraudsters file claims for services never received, forge or alter bills, or use another person's coverage or insurance card. Check each explanation of benefits.","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"special-investigations-phone","type":"phone","label":"Cigna Healthcare Special Investigations hotline (report fraud)","value":"+1-800-667-7145","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-email","type":"email","label":"Cigna Healthcare Special Investigations (report fraud)","value":"specialInvestigations@evernorth.com","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"},{"id":"special-investigations-mail","type":"mail","label":"Cigna Healthcare Special Investigations (report fraud by mail)","value":"Cigna Healthcare Special Investigations, 900 Cottage Grove Road W3SIU, Hartford, CT 06152","source":"https://www.cigna.com/legal/members/report-fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.968,"sources":{"primary":30,"other":1},"verified_from":{"page":16},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 97% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"dossier":{"title":"Cigna Healthcare — how complaints actually go","last_verified":"2026-10-12","file":"dossiers/cigna.md","markdown":"## In short\n\nCall Cigna customer service (1-800-997-1654, 24/7) or the number on your ID card, get the denial reason in writing, and file the internal appeal with Cigna's medical appeal form within the deadline in the denial letter. Whether external review is run by your state or under federal ERISA rules depends on whether the plan is fully insured or self-funded by the employer, so ask. Cigna's claim-review practices have drawn press scrutiny, and appeals often succeed. Be wary of \"free\" tests that ask for your insurance information; report fraud to Cigna's Special Investigations hotline at 1-800-667-7145.\n\n## How complaints actually go\n\n- Customer service is 1-800-997-1654 and medical, dental and vision coverage and claims is 1-800-244-6224, both 24/7; behavioral health is 1-800-433-5768. Live chat (myCigna sign-in) runs Monday-Friday, 9 a.m.-8 p.m. ET for some products. [Cigna contact us](https://www.cigna.com/contact-us/)\n- The contact page lists no specific complaint or appeal line; Cigna's member rights page says to call Customer Service at the toll-free number on your ID card, and that Cigna will guide members through the grievance process if they disagree with a decision. [Cigna member rights](https://www.cigna.com/legal/members/member-rights-and-responsibilities)\n- Appeal forms are on Cigna's customer forms page: the Medical Appeal Request, an Appointment of Representative form, and a separate Evernorth behavioral health appeal form for behavioral health denials. [Cigna customer forms](https://www.cigna.com/individuals-families/member-guide/customer-forms)\n- After the internal appeal, ask for external review within 4 months of the final denial; the insurer must follow the reviewer's decision. [HealthCare.gov: external review](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/)\n\n## What tends to work\n\n- Appeal. In Medicare Advantage, The Cigna Group overturned 96.0 percent of appealed denials for skilled nursing facility admission in June 2024. [HHS OIG OEI-09-24-00331, June 2026](https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf)\n- Ask why a claim was denied and who reviewed it. In 2023, ProPublica and The Capitol Forum reported that Cigna doctors denied over 300,000 payment requests in two months through a \"procedure-to-diagnosis\" (PXDX) review, spending an average of 1.2 seconds per case; Cigna called the description \"incorrect\" and said the reviews happen after care is given and do not deny care. [ProPublica, March 2023](https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims)\n- Language interpretation and TTY services are available for complaint and appeal processes; ask for them. [Cigna member rights](https://www.cigna.com/legal/members/member-rights-and-responsibilities)\n\n## Traps and fine print\n\n- Claims, explanations of benefits and chat need a myCigna sign-in, and chat is English only. [Cigna contact us](https://www.cigna.com/contact-us/)\n- Claims go to product-specific mailing addresses (medical: Cigna Healthcare, PO Box 182223, Chattanooga, TN 37422-7223); appeals go to the address on the denial letter. [Cigna contact us](https://www.cigna.com/contact-us/)\n- Cigna's external review request form on the forms page is for certain Virginia plans only; other members should follow the external review steps in the denial letter or call the number on the ID card. [Cigna customer forms](https://www.cigna.com/individuals-families/member-guide/customer-forms)\n- Missing the 180-day internal appeal window under the federal rules ends the right to appeal. [HealthCare.gov: internal appeals](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/)\n\n## By the numbers\n\n- Medicare Advantage, June 2024: The Cigna Group denied 8.8 percent of skilled nursing facility admission requests (239 of 2,705) and overturned 48 of 50 appealed denials. [HHS OIG OEI-09-24-00331, June 2026](https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf)\n\n## Scams that target customers\n\n- Cigna warns about promotions that offer free tests, treatment or services, especially when a provider asks for your insurance information. [Cigna: report fraud](https://www.cigna.com/legal/members/report-fraud)\n- Report suspected fraud to Cigna Healthcare Special Investigations: 1-800-667-7145, specialInvestigations@evernorth.com, or 900 Cottage Grove Road W3SIU, Hartford, CT 06152. [Cigna: report fraud](https://www.cigna.com/legal/members/report-fraud)\n- \"Free\" genetic tests offered by phone, at events or door to door are used to steal Medicare information; refuse kits your doctor did not order. [HHS OIG genetic testing alert](https://oig.hhs.gov/fraud/consumer-alerts/fraud-alert-genetic-testing-scam/)\n"},"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}