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Home Individuals & Families Member GuideClaims and Explanation of Benefits (EOBs)
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What is a claim?

A claim is a request to be paid, similar to a bill. If you recently went to the doctor and received care, you or your doctor will submit or “file” a claim. In most cases, if you received in-network care, your provider will file a claim for you. When Cigna receives a claim, it’s checked against your plan to make sure the services are covered. Once approved, we pay the health care provider or reimburse you, depending on who submitted the claim. Any remaining charges that weren’t covered by your plan are billed directly to you by your provider.

Cigna's claims process

When we receive a claim, we check it against your plan to make sure the services are covered. In some cases, you need to have a procedure, medication, or location pre-approved by Cigna before you receive care, otherwise the claim may be denied. This is known as prior authorization.

If you purchased coverage on your own through a state or federal marketplace, the plan may require that you see providers in the plan’s network; the claim may be denied for out-of-network services.

When a claim is approved, we either pay the health care provider directly or you do, depending on who submitted the claim. In most cases for in-network care, providers will submit claims for you and you’ll receive an explanation of benefits, or EOB.

Your EOB is not a bill but an explanation of how your claim was paid. The provider will bill you directly for any amounts you owe to them under your plan.

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What is an EOB?

An EOB (Explanation of Benefits) is a claim statement that Cigna sends to you after a health care visit or procedure to show you how your claim was paid.

An EOB is not a bill. It is a document to help you understand how much each service costs, what your plan will cover, and how much you will have to pay when you receive a bill from your health care provider or hospital.

Remember to save your EOBs for tax purposes and for your records.

Find out more about EOBs [PDF]

How do I submit a claim?

To submit a medical, dental, or mental health claim:
  • Download and print the appropriate claim form (depending on the type of claim)
  • Follow the instructions included on the form to complete it
  • Mail your completed claim to the address shown on the form
To submit a supplemental health claim:

Have a supplemental plan? (Hospital Indemnity, Cancer Treatment, Lump Sum Heart Attack and Stroke, or Whole Life Insurance.) Submit an online claim

Or, if you prefer to fill out a paper form, visit SuppHealthClaims.com to download a claim form.

Submit completed paper supplemental claims using one of these options:

  • Email: SuppHealthClaims@Cigna.com
  • Fax: 1 (860) 730-6460
  • Mail:
    Cigna Phoenix Claim Services
    PO Box 55290
    Phoenix, AZ  85078

What if my claim is denied?

In some cases, you need to have a procedure or service pre-approved by Cigna before you receive care, otherwise the claim may be denied.

Ways to avoid denied claims:

  • Pay your monthly premium on time
  • Present your current ID card when you receive services.
  • Stay in-network, if required by the plan
  • Get prior authorization, if required by the plan

A retroactive denial is a claim paid by Cigna and then later denied, requiring you to pay for the services. Denial could be due to eligibility issues, service(s) determined to be not covered by your plan, or cancellation of coverage.

If your claim is retroactively denied, Cigna will notify you in writing about your appeal rights. Learn more about appeals and grievances.

For help, call customer service at .

How do I know if I need to submit a claim?

In some cases you may need to submit a claim, depending on your plan type and whether you received in-network or out-of-network care. Use the following general plan information to help decide if you need to submit a claim.

HMO, Network, or EPO Plans

In-Network

For most services covered under your plan, you are not responsible for submitting a claim. Just show your Cigna ID card and (if applicable) pay your copayment at the time of service, or coinsurance after your claim is processed.

It is a good idea to compare your medical bill and EOB before paying a bill to make sure that you have been charged the correct amount.

Out-of-network

Most HMO, Network, and EPO plans only include out-of-network coverage for emergency care. Some plans may also cover urgent care services, as defined in your plan documents.

In this instance, you will usually need to submit a claim since out-of-network providers are not required to submit a claim on your behalf.

Point of Service Plans

In-network

You are not responsible for submitting a claim. Just show your Cigna ID card and pay your copayment at the time of service.

It is a good idea to compare your medical bill and EOB before paying a bill to make sure that you have been charged the correct amount.

Out-of-network

You will always need to submit a claim.

Indemnity Plans

You or your provider will need to submit a claim.

Depending on the provider, you may have to pay for the cost of your health care services when you receive them, or you may be billed directly for any services provided.

However, your provider will often take care of submitting a claim with Cigna so that you will be reimbursed. If your provider does not submit a claim, you will need to submit one in order to be reimbursed. In both cases, you will be reimbursed based on the amount covered by your plan and subject to your plan’s deductible, copay, or coinsurance requirements.

Visit our Knowledge Center to learn about:

How Health Insurance Works

Understanding Your Explanation of Benefits (EOB)

In-Network vs. Out-of-Network Providers

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