Cigna Appeal Letter Template: Complete 2025 Guide with Free Downloads

Understanding Cigna's Appeal Structure

Cigna Healthcare covers over 18 million Americans through commercial insurance, Medicare Advantage (Cigna HealthCare of Seniors), and Medicaid managed care plans. The company operates a streamlined national appeals process through the National Appeals Unit (NAU) in Chattanooga, TN, making submission more consistent than state-based insurers like BCBS.

For Cigna prior authorization templates and guidance, see our Cigna prior authorization template guide.

Key Cigna Plan Types:

• Commercial Plans: Employer-sponsored and individual market (PPO, HMO, EPO, POS)
• Medicare Advantage: Cigna HealthCare of Seniors / Cigna Medicare Advantage
• Medicare Part D: Prescription drug coverage through Cigna or Express Scripts
• Medicaid Managed Care: State-specific Community Care plans

Cigna's EviCore Partnership

Cigna uses EviCore (a utilization management company) for prior authorization reviews on imaging, cardiology, oncology, and specialty services. EviCore denials are appealed through Cigna's standard appeal process, but you may need to cite EviCore clinical guidelines in addition to Cigna Medical Coverage Policies.

When to File a Cigna Appeal: Denial Types & Deadlines

Filing Deadlines by Plan Type

Commercial Plans:

• 180 days from date on Explanation of Benefits (EOB) or denial letter
• Some plans allow longer periods (check your SPD)

Medicare Advantage:

• 65 days from date of organization determination (coverage decision)
• Expedited appeals: File immediately when health at risk

Medicare Part D:

• 60 days from coverage determination denial
• Handled by Cigna Pharmacy department or Express Scripts

Medicaid Managed Care:

• 60 days from Notice of Action (state-specific variations)

Level 2 Appeals (After Level 1 Denial):

• 60 days from Level 1 decision date

Common Cigna Denial Reasons Worth Appealing

Medical Necessity Denials (70-78% overturn rate):

• "Does not meet Cigna Medical Coverage Policy criteria"
• "Not medically necessary per clinical review"
• "Service considered investigational or experimental"
• "Insufficient clinical documentation"

Prior Authorization Denials (80-85% overturn rate with peer-to-peer):

• "Prior authorization/precertification not obtained"
• "Does not meet EviCore clinical criteria" (imaging, cardiology services)
• "Alternative treatment should be tried first" (step therapy)
• "Service should be performed in different setting"

Administrative Denials (85%+ overturn rate):

• Coding errors or mismatches
• Timely filing disputes
• Out-of-network when network inadequacy exists
• Duplicate claim denials (when services were separate)

Essential Components of a Winning Cigna Appeal Letter

1. Complete Identification Information

Patient Demographics:

• Full legal name
• Date of birth
• Cigna Member ID (check ID card format)
• Group number (if employer-sponsored)
• Plan type (PPO, HMO, EPO, Medicare, Medicaid)

Provider Information:

• Provider name with credentials
• Medical license number and state
• National Provider Identifier (NPI)
• Tax ID (TIN)
• Practice address, phone, fax, email

2. Clear Denial Identification

• Denial date
• Claim number (from EOB)
• Service/procedure denied with CPT/HCPCS codes
• Date of service
• Denial reason (exact language from EOB)
• Remark code (if provided)
• Billed amount

3. Cigna Medical Coverage Policy Citation

Cigna uses Medical Coverage Policies (similar to Aetna CPBs, UHC CDGs, BCBS Medical Policies) that define when services are medically necessary.

Finding Cigna Medical Coverage Policies:

1. Visit CignaForHCP.com → Clinical Resources → Coverage Policies
2. Search by procedure name or CPT code
3. Note the policy number and effective date

In Your Appeal:

According to Cigna Medical Coverage Policy #[NUMBER] - [TITLE]
(effective [DATE]), [service] is considered medically necessary when:

"[Quote exact policy criterion #1]"

[Patient Name] meets this criterion because:
- [Specific clinical evidence]
- [Objective finding]
- [Documentation reference]

"[Quote criterion #2]"

[Patient Name] meets this criterion as evidenced by:
- [Clinical data]
- [Test result]
- [How this satisfies criterion]

[Continue for ALL policy criteria]

4. Medical Necessity Justification

• Patient clinical history: Diagnosis (ICD-10), symptoms, exam findings, functional limitations
• Evidence-based support: Medical society guidelines, peer-reviewed research, FDA approval status
• Expected outcomes: Measurable goals, timeline, consequences of denial

5. Supporting Clinical Documentation

• Clinical records (office notes, test results, previous treatment records)
• Policy documentation (Cigna Medical Coverage Policy excerpts)
• Evidence base (clinical guidelines, peer-reviewed abstracts)
• Administrative documents (denial letter, prior auth denial, treatment order)

6. Timeline Compliance Statement

"This appeal is submitted within the 180-day filing deadline, [X] days after receiving the denial notice dated [Date]."

7. Peer-to-Peer Request

"I am available for peer-to-peer review with a Cigna medical director at your earliest convenience. Please contact me at [phone] or [email]."

Template 1: Commercial Plan Appeal Letter

[Date]

Cigna Healthcare Inc.
National Appeals Unit (NAU)
P.O. Box 188011
Chattanooga, TN 37422

RE: Level 1 Appeal - Medical Necessity Denial
Member: [Patient Full Name]
Member ID: [Cigna ID Number]
Date of Birth: [MM/DD/YYYY]
Group #: [Group Number]
Claim #: [Claim Number from EOB]
Date of Service: [MM/DD/YYYY]
Provider: [Your Practice Name]
Provider NPI: [Your NPI Number]
Provider TIN: [Tax ID]

Dear Cigna Medical Director:

I am writing to appeal the denial of coverage for [SPECIFIC SERVICE/PROCEDURE] provided to the above-referenced patient on [DATE]. This appeal is submitted [X] days after the denial dated [DENIAL DATE], within the required 180-day filing deadline.

DENIAL IDENTIFICATION:
Cigna denied this claim stating: "[exact denial language from EOB]" (Remark Code: [code if provided]). This denial is medically inappropriate and should be overturned based on the patient's clinical presentation and compliance with Cigna Medical Coverage Policy #[NUMBER].

PATIENT CLINICAL PRESENTATION:
[Patient Name] is a [age]-year-old [gender] diagnosed with [CONDITION] (ICD-10: [CODE]).

Current Clinical Status:
- [Objective finding #1 with measurement]
- [Objective finding #2]
- [Functional limitations]
- [Diagnostic test results]

Previous Conservative Management:
1. **[Treatment #1]:** [Duration, dates] - Outcome: [Objective result, why insufficient]
2. **[Treatment #2]:** [Duration, dates] - Outcome: [Result, inadequate]
3. **[Treatment #3]:** [Duration, dates] - Outcome: [Result, continued symptoms]

Despite adequate conservative treatment, [Patient Name] requires the denied service.

CIGNA MEDICAL COVERAGE POLICY COMPLIANCE:
According to Cigna Medical Coverage Policy #[NUMBER] - [POLICY TITLE] (effective [DATE]), [service] is considered medically necessary when:

**Policy Criterion 1:** "[Quote exact Cigna policy language]"

[Patient Name] meets this criterion:
- [Specific clinical evidence]
- [Objective measurement]
- [Documentation reference]

**Policy Criterion 2:** "[Quote exact policy language]"

[Patient Name] meets this criterion:
- [Clinical finding]
- [Test result]
- [Compliance explanation]

[Continue for ALL Cigna policy criteria]

CLINICAL GUIDELINE SUPPORT:
**[Medical Society] Guidelines ([Year]):**
"[Quote specific recommendation]"

**Peer-Reviewed Evidence:**
[Author et al.], [Journal], [Year]: [Key finding supporting medical necessity]

MEDICAL NECESSITY RATIONALE:
[2-3 paragraphs explaining why this treatment is necessary, expected outcomes, consequences of denial]

SUPPORTING DOCUMENTATION:
- Office visit notes from [dates]
- [Diagnostic test] results from [date]
- Previous treatment records
- Cigna Medical Coverage Policy #[number] excerpts
- Clinical guideline excerpts
- Peer-reviewed research
- Letter of medical necessity

RELIEF REQUESTED:
I respectfully request that Cigna overturn this denial and approve payment for [service, CPT codes] in the amount of $[billed amount] as medically necessary per Cigna Medical Coverage Policy #[number].

PEER-TO-PEER REVIEW:
I am available for peer-to-peer review:
- Direct Phone: [phone]
- Cell: [cell if provided]
- Email: [email]

TIMELINE:
This appeal is submitted [X] days after the denial dated [DATE], within the 180-day deadline. I request a response within 30 days [pre-service] or 60 days [post-service] per Cigna appeal procedures.

Sincerely,

[Physician Signature]
[Physician Name, MD/DO with Credentials]
Medical License #: [Number]
NPI: [Number]
TIN: [Tax ID]
[Practice Name and Address]
[Phone] | [Fax] | [Email]

Enclosures: [List 8-12 attachments]

Template 2: Medicare Advantage Appeal Letter

[Date]

Cigna HealthCare of Seniors
National Appeals Unit
P.O. Box 188011
Chattanooga, TN 37422

RE: Medicare Advantage Organization Determination Appeal
Member: [Patient Name]
Medicare Advantage Plan: [Specific Cigna MA plan]
Member ID: [Medicare ID]
Claim #: [Claim Number]
Date of Service: [MM/DD/YYYY]

Dear Cigna Medicare Medical Director:

I am filing an organization determination appeal under Medicare Advantage regulations for the denial of [service] for the above Medicare beneficiary. This appeal is filed [X] days after the denial dated [DATE], within the required 65-day deadline.

DENIAL REASON:
Cigna Medicare denied coverage stating: "[exact denial language]." This contradicts Medicare coverage policy and medical necessity standards.

MEDICARE COVERAGE CRITERIA:
**CMS NCD/LCD [if applicable]:**
[Number and title]: "[Quote Medicare coverage criteria]"

**Cigna MA Coverage Policy:**
"[Quote Cigna Medicare Advantage policy language]"

PATIENT MEETS MEDICARE CRITERIA:
[Patient Name], a Medicare beneficiary age [XX], meets all criteria:
1. [First criterion with evidence]
2. [Second criterion with evidence]
3. [Continue]

CLINICAL JUSTIFICATION:
[Medical necessity argument following same structure as Template 1]

MEDICARE APPEAL RIGHTS:
As a Medicare Advantage enrollee, [Patient Name] has the right to organization determination review, IRE reconsideration if denied, and ALJ hearing if applicable.

If Cigna Medicare does not respond within 30 days (or 72 hours if expedited), this appeal will automatically advance to Independent Review Entity (IRE) per CMS regulations.

RELIEF REQUESTED:
Overturn the denial and authorize coverage per Medicare Advantage provisions and Medicare coverage policy.

PEER-TO-PEER REVIEW:
Available at [phone] or [email].

Decision requested within 30 calendar days (or 72 hours if expedited).

Sincerely,

[Signature and Credentials]

Enclosures:
- Denial notice
- Clinical documentation
- Medicare NCD/LCD excerpts
- Cigna MA policy documentation

Template 3: Expedited/Urgent Appeal

[Date]

**EXPEDITED APPEAL REQUEST - URGENT**

Cigna Healthcare
Urgent Appeals Department
Fax: [Urgent fax from denial letter]
Phone: 1-800-88-CIGNA (882-4462)

RE: EXPEDITED Appeal - Urgent Medical Necessity
Member: [Patient Name]
Member ID: [Cigna ID]
Claim/PA #: [Number]

Dear Cigna Urgent Review Medical Director:

I am requesting EXPEDITED appeal review for [service] due to urgent medical necessity. Standard timelines (30-60 days) pose unacceptable risk to this patient's health.

URGENT CLINICAL SITUATION:
[Patient Name] requires immediate [treatment] due to [urgent condition]. Delay will result in [specific harm].

Current Urgent Status:
- [Urgent finding #1 with data]
- [Urgent finding #2]
- Risk of Delay: [Specific clinical consequence]
- Timeline: Without treatment within [timeframe], patient will experience [adverse outcome]

MEDICAL NECESSITY:
**Diagnosis:** [Diagnosis, ICD-10]

**Why Immediate Treatment Necessary:**
[2-3 paragraphs on urgency, why can't wait, expected deterioration]

**Cigna Policy Compliance:**
Per Cigna Medical Coverage Policy #[NUMBER], [service] is necessary when [quote criterion]. Patient meets this urgently.

**Clinical Guidelines:**
[Medical Society] guidelines recommend [quote urgency recommendation].

PREVIOUS DENIAL:
Cigna denied on [date] stating "[reason]." This is inappropriate given urgency and clinical evidence.

PEER-TO-PEER IMMEDIATE AVAILABILITY:
Available 24/7:
- Phone: [phone]
- Cell: [cell]
- Email: [email]

TIME-SENSITIVE REQUEST:
I request decision within **72 hours** per Cigna expedited procedures to prevent irreversible harm.

RELIEF REQUESTED:
Immediate authorization for [service] to begin [timeline].

Sincerely,

[Signature and Credentials]

**SUBMITTED VIA FAX: [Date/Time]**
**Follow-up call to confirm expedited processing**

Enclosures: Urgent clinical documentation

Cigna Appeal Submission: Addresses & Contact Information

Primary Appeal Addresses

Standard Commercial Plans: Cigna Healthcare Inc. National Appeals Unit (NAU) P.O. Box 188011 Chattanooga, TN 37422

Plans with "GWH-Cigna" or "G" on ID Card: Cigna Healthcare Inc. National Appeals Unit (NAO) P.O. Box 188062 Chattanooga, TN 37422

EviCore-Related Denials (Imaging, Cardiology, etc.): EviCore Claim Appeals P.O. Box 5620 Hartford, CT 06102

Medicare Advantage: Cigna HealthCare of Seniors National Appeals Unit P.O. Box 188011 Chattanooga, TN 37422

Medicare Part D: Check your denial letter for pharmacy-specific address

Phone & Fax Options

Provider Services: 1-800-88-CIGNA (882-4462) Expedited Appeals: Same number, state "urgent appeal request" Fax: Check denial letter for fax number (varies by plan)

Confirmation & Tracking

• Use certified mail with return receipt for paper submissions
• Keep copy of all documents submitted
• If no confirmation within 7-10 business days, call Provider Services
• Document submission date for 180-day deadline tracking

Cigna Medical Coverage Policies: How to Find & Cite

Finding Cigna Coverage Policies

Step 1: Visit CignaForHCP.com → Clinical Resources → Coverage Policies Step 2: Search by procedure name or CPT code Step 3: Note policy number and effective date Step 4: Download full policy PDF

Policy Structure

• Policy Number & Title
• Effective Date and Last Review Date
• Coverage Criteria (requirements for medical necessity—CRITICAL)
• Exclusions/Limitations
• References (clinical guidelines, evidence)

Citing in Your Appeal

Format:

According to Cigna Medical Coverage Policy #[NUMBER] - [TITLE]
(effective [DATE], last reviewed [DATE]), [service] is medically
necessary when:

"[Quote exact criterion #1]"

[Patient] meets this criterion: [evidence]

"[Quote criterion #2]"

[Patient] meets this criterion: [evidence]

Common Cigna Denial Reasons & Counter-Arguments

"Does not meet Cigna Medical Coverage Policy"

Counter: Cite specific policy number, quote all criteria, demonstrate criterion-by-criterion compliance with objective clinical evidence. Reference clinical guidelines supporting medical necessity. Document previous conservative treatments if applicable.

"Service deemed investigational or experimental"

Counter: (1) FDA approval documentation with date, (2) Medical society guidelines endorsing as standard care, (3) Peer-reviewed studies demonstrating efficacy, (4) Comparable Cigna coverage for similar indications.

"Alternative treatment should be tried first"

Counter: (1) Document prior treatment failures with dates and objective outcomes, (2) Medical contraindications to suggested alternatives, (3) Guidelines supporting requested treatment as first-line, (4) Clinical urgency requiring immediate definitive treatment.

Cigna Appeal Response Times

Standard Timelines

Commercial:

• Pre-service: 30 days
• Post-service: 60 days

Medicare Advantage:

• Standard: 30 days
• Expedited: 72 hours

Medicare Part D:

• Redetermination: 7 days

What to Expect

Days 1-7: Appeal logged, assigned to medical director Days 7-20: Clinical review, peer-to-peer if requested Days 20-30/60: Final decision, letter sent

If No Response: Call Cigna Provider Services at 1-800-88-CIGNA to request status

How Muni Automates Cigna Appeals

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Manual (40-50 minutes): Search Cigna policy database → Read policy → Extract criteria → Draft response → Format letter

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Frequently Asked Questions

How long do I have to file a Cigna appeal?

180 days from the date on your EOB or denial letter for commercial plans. 65 days for Medicare Advantage organization determinations. 60 days for Medicare Part D coverage determinations and 60 days for Level 2 appeals after Level 1 denial. Missing deadlines forfeits appeal rights. Set calendar reminder for 150 days (commercial) or 55 days (MA/Part D) to allow prep time.

Where do I send my Cigna appeal?

Most commercial plans: Cigna Healthcare Inc., National Appeals Unit, P.O. Box 188011, Chattanooga, TN 37422. EviCore denials: P.O. Box 5620, Hartford, CT 06102. Always verify the appeal address printed on your specific denial letter, as Cigna routes certain plans to different addresses. Call 1-800-88-CIGNA if no address provided.

What is the difference between Cigna and EviCore for appeals?

Cigna is the insurance company. EviCore is Cigna's utilization management partner handling prior authorization for imaging, cardiology, oncology, and specialty services. EviCore denials are appealed through Cigna's process but may require a different submission address (P.O. Box 5620, Hartford, CT 06102). Cite both EviCore clinical criteria and Cigna Medical Coverage Policies in your appeal for EviCore-related denials.

How long does Cigna take to respond to appeals?

Commercial plans: 30 days (pre-service) or 60 days (post-service). Medicare Advantage: 30 days standard, 72 hours expedited. Medicare Part D: 7 days. If no response within required timeframe, call Cigna Provider Services at 1-800-88-CIGNA to request status and expedited resolution. Peer-to-peer reviews typically occur within 5-7 days and accelerate final decisions.

Should I request peer-to-peer review in my Cigna appeal?

Yes. Peer-to-peer reviews increase overturn rates by 15-20%. Always include: "I am available for peer-to-peer review with a Cigna medical director at [phone] or [email]." Provide direct number and availability. Cigna typically schedules within 5-7 business days, with decisions often following within 48 hours after the call.

What happens if my Cigna Level 1 appeal is denied?

You can file Level 2 internal appeal within 60 days of Level 1 decision. Level 2 involves different medical director or appeals committee. If Level 2 denied, you may pursue external review through your state's independent review process (if medical necessity denial exceeding state threshold amount). Medicare Advantage denials can be appealed to Independent Review Entity (IRE).

How do I submit an expedited Cigna appeal?

Call Cigna Provider Services: 1-800-88-CIGNA, state "expedited appeal request." Submit via fax (number on denial letter) marked "EXPEDITED - URGENT." Document urgent clinical situation, specific harm from delay, why immediate treatment necessary. Provide 24/7 contact for peer-to-peer. Request 72-hour decision. Follow up 4-6 hours after submission to confirm expedited processing.

Where do I find Cigna Medical Coverage Policies?

Visit CignaForHCP.com → Clinical Resources → Coverage Policies. Search by procedure name or CPT code. Note policy number and effective date. Download full PDF. If online access unavailable, call Cigna Provider Services at 1-800-88-CIGNA and request specific Medical Coverage Policy by service name or CPT code.

Can I cite medical society guidelines to strengthen my Cigna appeal?

Yes. Use format: [Society Name] [Guideline Title] ([Year]): "[Direct quote]." Example: "American Heart Association Guidelines for Stress Testing (2023): 'Stress testing is recommended for patients with intermediate pretest probability of coronary disease (Class I, Level A).' Patient has intermediate probability, meeting guideline criteria." Cite 2-3 guidelines plus Cigna Medical Coverage Policy for strongest appeals.

Do Cigna Medicaid plans have different appeal procedures?

Yes. Cigna Medicaid managed care (Community Care plans) follow state Medicaid regulations. Differences may include: state-specific forms, shorter timelines (often 60 days vs 180 days), different appeal addresses by state, state Medicaid policies superseding Cigna policies. Check your Medicaid denial letter for state-specific procedures.

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This guide reflects October 2025 Cigna Healthcare appeal procedures for commercial, Medicare Advantage, and Medicare Part D plans. Cigna Medical Coverage Policies are updated regularly—verify current policies at CignaForHCP.com. Muni Appeals maintains current Cigna policies and handles EviCore-related denials.