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.
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.
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.
How do I submit a 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
Have a supplemental plan? (Hospital Indemnity, Cancer Treatment, Lump Sum Heart Attack and Stroke, or Whole Life Insurance.)
Or, if you prefer to fill out a paper form, visit
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
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.
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.
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.
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.
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Disclaimer
Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates ( see