Pre-Authorization FAQs

Pre-authorization protects you and Cigna from unnecessary tests, cost, radiation, and surprise medical bills. The process seeks input from clinical pharmacists and medical doctors to review how necessary a medical procedure/treatment or medication may be in treating your condition. For example, some brand-name medications are very costly. Cigna’s review may determine that a generic medication or another lower-cost alternative may work just as well in treating your medical condition or that a different drug should be substituted due to interactions with your medications.

Your doctor will submit a pre-authorization request to your insurance company (Cigna) in advance to determine if a medical procedure, imaging, treatment, medications and/or equipment are medically necessary. They should supply information that supports the request.

Cigna will review the request and do one of the following:

• Approve the request
• Ask for more information
• Recommend you try an alternative that is less costly but equally effective before the original request is approved
• Deny the request

It can take 10 to 12 business days from the time your doctor submits the request for the authorization to be approved by Cigna. Your provider will be notified, and you will also receive a letter, but the quickest way to find out if your request is approved is to follow up with your doctor regularly.

If you have an urgent need, your doctor can request an expediated review, which can take up to 72 hours.

Remember that the clock on the review process doesn’t start until your provider submits the request complete with documentation. If it isn’t a complete request, it will add delays.

There are ways to facilitate getting the denial overturned. First, you’ll want to start with your doctor and find out why it was denied. Most of the time, it’s a matter of missing information, and once your doctor has followed up, the request may be approved.

Your provider can appeal the denial, and they can also speak with Cigna’s medical director. This conversation is called a peer-to-peer, and it is a good way for your doctor to make your case for you.

If the denial is not overturned, speak with your doctor about other options available to you for treatment.

Once you have your approval, go to MyCigna.com and do a search and compare to make sure you are getting a provider/facility that is in network, with manageable costs. If you need assistance with this, contact our Cigna onsite representatives.

No. For conditions requiring immediate attention, urgent care centers and emergency rooms can provide treatment without submitting a request for pre-authorization.

Yes.

• If your provider is in-network, they are responsible for submitting the request, providing any needed documentation, following up, and keeping you informed.
• If your provider is out-of-network, the responsibility for submitting the request is yours, but your provider should be able to help guide you.
• To get the most out of your benefits and keep costs down, it’s a good idea to stay in-network.