How can I understand my mental health benefits?
Your behavioral benefits may be different from your medical benefits. So it's important to know exactly what your behavioral benefits are. To learn more about your specific behavioral health benefits, call the number listed on your insurance ID card. We will help you figure out what's covered under your plan.
Which behavioral health services are covered?
Services are available and covered for a wide range of issues. These include mental health and substance use disorder. Your behavioral health provider will evaluate your needs and treatment course. Cigna care management staff will review your recommended treatment to determine if benefits are available.
Behavioral health services that are covered by most plans include:
- Outpatient individual therapy: This treatment involves regular meetings with a therapist. You and your therapist will work together to create a treatment plan. This includes creating goals for your treatment. Goals will be set for improving your health, reducing your symptoms, and learning self-management skills.
- Outpatient Family Therapy: This involves regular meetings with a therapist, yourself, and your family. One goal for this treatment is to educate your family about your illness. Therapy will also aim to teach them skills to support you in managing your illness.
- Outpatient Group Therapy: This involves meetings with a therapist, yourself and a group of others. These folks are dealing with similar issues. This treatment aims to provide you with support from others. You'll also pick up helpful tips and skills to manage your illness.
- Medication Management: This treatment involves regular meetings with a psychiatrist. You'll work together to build the best medication plan and treatment for you. Your psychiatrist will monitor you to make sure medications are working.
Do I need prior authorization?
If you see a provider in your Cigna plan's network, these treatment services usually don't need prior authorization. Your health care provider will need to submit claims for any services provided.
If you are looking for inpatient or facility based treatment, please call or have your provider call Cigna at the number on your Cigna ID card.
If you see an out-of-network provider, call us to find out what's covered.
What does "medical necessity" mean?
Cigna will work with your doctor or behavioral health provider. Together, we'll determine the right level and length of treatment for you. You and your provider will build a plan that includes specific goals. When you reach these goals, it means that treatment is no longer necessary.
For further explanation of medical necessity, review our Medical Necessity Criteria for Treatment of Behavioral Health and Substance Use Disorders.
This material is provided by Cigna for informational/educational purposes only. It is not medical/clinical advice. Only a health care provider can make a diagnosis or recommend a treatment plan. For more information about your behavioral health benefits, you can call the member services or behavioral health telephone number listed on your health care ID card.