You have perhaps wondered whether you can find quality drug rehab in Phoenix. Finding one significantly increases the chances of long-term recovery and reduces the risk of a relapse or health complications. The quality of care provided and evidence-based treatments used also ease recovery.
Many people are confused about what a Cigna insurance plan covers. This confusion is due to the variety of plan types that have different networks, costs, and rules. This article will provide you with a complete, clear guide to understanding the benefits at your disposal and how to use them.
If you’re considering Cigna coverage or need guidance with your insurance plans, please talk to our team at Nirvana Recovery for help. We are a resource for verifying insurance coverage and helping with treatment planning.
Overview of Cigna Insurance and Addiction Treatment Coverage
About Cigna as a Health Insurance Provider
The Cigna Group is a health service company with its headquarters in Bloomfield, Connecticut. It serves more than 30 countries and jurisdictions, with over 64,000 employees as of 2025. It has more than 2 million relationships with facilities, clinics, and healthcare providers, and over 178 million customer relationships.
Cigna’s commitment to behavioral health services is seen in its partnership with Ginger to provide in-network coverage for on-demand behavioral health coaching, psychiatry, and therapy services. This has reached its 14 million behavioral health customers.
Cigna aims to prevent the early onset of severe mental health conditions through its early access to behavioral health coaching. Coaches are trained to address a wide array of mental health issues and identify the need for higher-level care.
Cigna’s Approach to Substance Use Disorder Treatment
Cigna recognizes addiction as a chronic disease, comparable to diabetes or cancer. It needs to be managed for a lifetime, which is a fact that some people struggle to come to terms with early on.
Cigna believes in helping protect those who may be at-risk and having a healthcare system that supports early detection. It further advocates for the adoption of a new mindset when addressing substance use disorders (SUDs) and avoiding blame words like “abuse.”
Individualized care in its plans helps match patients with the providers who are best suited to address their condition. The Cigna Total Behavioral Health program particularly provides its members access to care navigators who deliver one-on-one personalized assistance. Care navigators help find available providers who can best attend to the individual’s preferences and needs.
Coverage Under the Affordable Care Act (ACA) and Parity Laws
The Affordable Care Act (ACA) has helped make health insurance more accessible and affordable. Since 2014, insurance plans have been required to cover ten Essential Health Benefit categories, one being mental health and substance use disorder services, including behavioral health treatment.
The ACA further mandates small group and individual market plans to treat mental health and SUD services as they would medical and surgical services.
The Mental Health Parity and Addiction Equity Act (MHPAEA) also mandates that health insurers and group health plans must not place more financial requirements, restrictions, or limitations on mental health or SUD services than medical and surgical services. They must be treated equally. This means that a health plan like Cigna should offer benefits that have the same financial requirements and treatment limitations as medical and surgical benefits.
Types of Cigna Plans in Phoenix and What They Cover
Employer-Sponsored Plans
The following are variations in Cigna coverage depending on employer plan tiers:
Cigna Open Access Plus (OAP): Makes quality, in-network care easy to access, with an extensive national network of providers. You don’t need specialist referrals and can also choose a primary care provider (PCP).
Preferred Provider Organization: Offers an extensive network of providers and facilities.
LocalPlus: Designed to be flexible and help control your healthcare costs. You get access to local, limited networks of healthcare providers, specialists, and hospitals.
Health Maintenance Organization: Offers a local network of hospitals and doctors.
Exclusive Provider Organization (EPO): Offers a national network of facilities and providers. However, out-of-network providers are not covered.
Medical Indemnity: Designed to give various choices of facilities and healthcare providers.
Medical Network Plans: Offer cost-effective access to a local network of quality hospitals, specialists, and doctors.
SureFit Plans: Provides care within a local community of care network.
Individual and Family Plans (Marketplace)
Here’s how network choice impacts costs for Cigna plans in Phoenix:
OAP plans provide a broad, national network of healthcare providers. However, they have higher monthly premiums due to the extensive network and flexibility.
LocalPlus plans have a more localized network, focused on specific regions. They have lower premiums than OAP plans due to their focus on a more limited network.
PPO plans have low out-of-pocket costs for visiting in-network providers. However, they offer flexibility to see any healthcare provider.
HMO plans require you to choose a PCP and get referrals for specialist care. While they have the lowest premiums, they come with restrictions.
Cigna Medicare Plans
Cigna offers Medicare plans to meet the needs of seniors and people with disabilities. Let’s have a look at the available options.
Medicare Advantage Plans
Cigna’s Medicare Advantage plans combine the benefits of Original Medicare with additional coverage. Cigna’s Special Needs Plans (SNPs) are designed to provide additional benefits to address the needs of people with specific health needs.
Medicare Supplement (Medigap) Plans
For those who prefer to keep Original Medicare, Cigna provides Medigap plans. They help pay coinsurance, deductibles, and copays. You can also choose any hospital or doctor that accepts Medicare, without requiring referrals (in most cases).
Medicaid Partnerships (If Applicable in Arizona)
Medicaid serves Arizona residents through the Arizona Health Care Cost Containment System (AHCCCS). Cigna offers Dual Special Needs Plans (D-SNPs) designed to coordinate your Medicare benefits with AHCCCS benefits when you’re dually eligible.
Additionally, Cigna provides financial assistance programs to reduce the healthcare costs of eligible individuals. Health insurance subsidies are also available, depending on your household size and income. People who qualify may get a health plan at a lower cost. If you qualify, the two ways you can save money on healthcare plan costs are by getting:
A premium tax credit
A cost-sharing reduction (CSR)
Differences Between HMO, PPO, and EPO Networks
Here’s how different plans differ in their network requirements:
HMO plans require you to use a network of facilities that have contracted with the HMO, limiting coverage for rehab facilities to those within the HMO network.
PPO plans allow you to access in-network and out-of-network rehab facilities. However, out-of-network care will come at higher out-of-pocket costs.
EPO plans require you to use a network of rehab facilities within the EPO network. They do not provide coverage for out-of-network rehab centers.
Drug Rehab Services Typically Covered by Cigna in Phoenix
Inpatient and Residential Treatment
Coverage Requirements
Care providers must justify why you need inpatient or residential treatment over a less intensive program. Treatment should be the least intensive level of care that addresses your needs effectively, in line with the American Society of Addiction Medicine (ASAM) principles.
Length of Stay
Cigna doesn’t cap your coverage at a specific number of days, like 30-90 days. Medical necessity determines the length of stay, which is regularly reassessed.
Pre-Authorization
Cigna mandates pre-authorization for inpatient and residential treatment. Care providers must get authorization before starting treatment. Cigna Behavioral Health’s clinical staff is available 24/7 to review and authorize coverage.
Outpatient and Intensive Outpatient Programs (IOP)
Routine Outpatient Treatment
You can have 1-2 sessions per week alone, in group therapy, or for medication management. The sessions are assessed based on clinical need and your treatment plan. Extended or multiple sessions that exceed 50 minutes per session or one session per week are reserved for acute or medically necessary cases. They also require justification.
Intensive Outpatient Program (IOP)
You can get 3-5 days per week, with each session lasting 3-4 hours. This structure is designed to allow you to continue with your regular daily routines.
Partial Hospitalization Programs (PHP)
A partial hospitalization program (PHP) is comparable in intensity to inpatient care. However, you’re allowed to return home at the end of the day. It’s usually used for crisis management or acute symptom reduction.
Cigna requires a one-on-one assessment by a qualified behavioral health clinician 72 hours before admission to a PHP. The evaluation must justify the need for that level of care.
Depending on your plan, Cigna may require pre-authorization for PHP services. Coverage also depends on your plan.
Medication-Assisted Treatment (MAT)
Buprenorphine is part of medication-assisted treatment (MAT). It’s prescribed in outpatient treatment to ease withdrawal, reduce cravings, and support long-term recovery from opioid use disorder (OUD).
Cigna has case managers who can partner with you on MAT to ensure adherence to this covered treatment. The induction phase of treatment and ongoing medication management do not require pre-authorization.
Cigna also covers FDA-approved medications for alcohol use disorder (AUD), like naltrexone, acamprosate, and disulfiram. The exact coverage depends on the specific plan.
Counseling and Therapy
Cigna covers individual, group, and family therapy in all its plans, but the exact access, session frequency, and limits depend on your specific plan.
Individual Therapy: One-on-one sessions with a licensed clinician are covered for the diagnosis of conditions like depression, anxiety, PTSD, and SUDs.
Group Therapy: Sessions are covered when clinically appropriate and are often used in IOP or PHP.
Family Therapy: Sessions are covered as part of behavioral health benefits.
Aftercare Services
Cigna covers relapse prevention and other ongoing aftercare services that are part of medically necessary treatment for substance use disorders. Such services include:
Outpatient care/therapy
IOP
PHP
Medication management
Formal relapse prevention group support
Coverage and limits depend on your specific plan, medical necessity, and whether the care provider or facility is in-network.
How to Verify Cigna Coverage for Rehab in Phoenix
Review Your Plan Documents
Here’s where you can find behavioral health benefits in your Cigna insurance policy and what you should look for:
Summary of Benefits and Coverage (SBC): Shows whether mental health or SUD services are covered
Evidence of Coverage (EOC) or Evidence of Benefits: Explains covered services, limits, pre-authorization rules, appeals, and care provider networks
Prescription Drug List: Shows medications used in SUD or psychiatric care, like buprenorphine, naltrexone, and antidepressants
Healthcare Provider Directory or Behavioral Health Network List: Shows in-network therapists, psychiatrists, programs, and facilities, and the coverage of telehealth
Contact Cigna Directly
Here are questions you should ask about coverage, deductibles, and copays:
Is a particular service covered under your plan? Services include inpatient or residential treatment, IOP, therapy, or MAT.
Is your healthcare provider or facility in-network for your plan? If not, will any part of their services be covered out-of-network?
If in-network, what are the copays, coinsurance, and deductibles that would apply to a particular service? If out-of-network, what would your responsibility be?
Does a particular service apply to the medical deductible, the behavioral health deductible, or both?
Is pre-authorization required? If so, what documentation is needed, who submits it, and how long does the review take?
Use a Rehab Facility’s Insurance Verification Service
Nirvana Recovery can confirm Cigna benefits quickly and accurately on your behalf. Here’s how we do it:
We gather your basic information and admission essentials like your full name, date of birth, member ID, and plan name, among other details.
We submit a 270 transaction or use Availity, Athena, or Office Ally. We will receive a 271 response to confirm your eligibility, plan type, in-network status, deductible, copays, and benefit flags for behavioral health.
We can use the Evernorth Behavioral Health provider portal or authorization tool to verify whether services like IOP require pre-authorization for your plan to submit authorizations. The Evernorth authorization and billing resource lists codes and requirements.
We can contact the general provider’s pre-authorization portal or Cigna behavioral help lines if our electronic tools don’t show everything.
Pre-Authorization Process
Pre-authorization is essential for the following reasons:
It determines whether Cigna will cover a requested level of care under your plan
It prevents inappropriate placements by matching the level of care you need to ASAM or medical necessity standards
It prevents heavy billing by ensuring the service you’re seeking is authorized
It directs you to the right clinical team, initializes case management, and connects care providers for follow-up
Authorizations with IDs and documented dates make claims decisions smoother and reduce authorization denials
Some medications and higher-level services require pre-authorization; getting it early prevents delayed treatments
Common Challenges with Cigna Rehab Coverage and How to Address Them
Denials and Appeals
The following are common reasons for denied claims:
Lack of medical necessity; claims that don’t meet Cigna’s criteria are often denied
Missing or incomplete documentation, like intake assessments, progress notes, or pre-authorization
Seeking the services of out-of-network providers in plans that don’t include them
Missing Cigna’s deadline for submitting claims
You can always appeal a denied Cigna claim. Follow these steps:
Understand the specific reason for denial and note any requests, like those for additional documentation
Try to solve issues, like missing details, over the phone
If contacting customer support doesn’t work, submit a formal written appeal
Support your appeal with documentation, including clinical notes, letters from providers, or face-to-face assessments
Out-of-Network Limitations
When a Cigna plan doesn’t include out-of-network facilities, you can’t access services from providers outside the network. If you had reasons for seeking care at out-of-network facilities, this limitation may hold you back.
But there are situations where Cigna may cover out-of-network facilities. They include the following:
Emergency care. The No Surprises Act mandates Cigna to cover emergency services at both in-network and out-of-network facilities at in-network rates.
Continuity of care. Cigna may allow you to continue treatment at in-network rates temporarily if you’re already undergoing treatment, like in a mental health program, and your provider goes out-of-network.
Some Cigna plan types, like PPOs, offer out-of-network coverage with higher out-of-pocket costs.
Coverage Caps and Limits
The ACA ensures that Cigna doesn’t impose annual or lifetime dollar caps on essential health benefits, such as:
Hospital care
Prescriptions
Behavioral health treatment
Mental health and substance use treatment
Some optional services may still have annual or lifetime limits, depending on the plan structure. They include elective dental, vision, or cosmetic procedures.
While the ACA prohibits dollar limits, some Cigna plans may include visit limits for some services. For example, it may limit your therapy visits to 60 days per year.
Cigna’s plans also have annual deductibles and out-of-pocket (OOP) maximums, which reset every year. Once you reach your OOP maximum, including deductibles, copays, and coinsurance, the plan starts paying 100% of covered costs.
Why Phoenix Residents Should Consider In-Network Facilities
Cost Savings
Cigna negotiates with in-network facilities and providers to offer care at discounted rates. This lowers your out-of-pocket costs, copays, coinsurance, and deductibles. Upon reaching your OOP maximum, Cigna plans cover 100% of covered services for the rest of the year.
Thanks to the contractual agreement between in-network providers and Cigna, providers or facilities can’t charge you beyond the agreed-upon rate, or what Cigna deems “allowed.” However, they can charge you the balance between what they bill and what Cigna pays.
Seamless Approval
In-network providers are familiar with Cigna’s pre-authorization process and required documentation. Providers in in-network facilities handle the paperwork on your behalf. Their familiarity leads to fewer or no errors and speeds up approvals. Some providers receive notification of approval within days.
Plans that allow you to have a PCP at in-network facilities make processes smoother. Your PCP handles your referrals and manages specialists. Having a PCP reduces confusion and delays.
You also get better outcomes and much fewer delays in programs that make registered nurse care coordinators and Cigna case managers available. They follow up after hospitalization, fill care gaps, and coordinate follow-up treatments.
Examples of In-Network Benefits in Phoenix
In-network benefits include getting local facility types and services covered. Here are the types of in-network facilities and services in Phoenix:
Residential Treatment Centers: Suitable for people looking for extra recovery support through therapies and other residential treatment programs
Intensive Outpatient Programs (IOPs): You get at least three sessions per week, with 10 to 20 total hours, and help with medication management
Outpatient Clinics and Counseling Centers: Provide individual, group, and family therapy using evidence-based techniques
Start Your Rehabilitation with Nirvana Recovery
Navigating Cigna coverage doesn’t have to be stressful. Nirvana Recovery provides resources like this article to make it easy. We understand the complexities you may face, especially when most concepts and terms are new to you. We aim to take away such complexities and provide straightforward comprehension and navigation.
Nirvana has expertise in both mental health and SUD treatment and insurance verification. We know the meeting point of your recovery and insurance needs and make it easy to achieve both. Our admissions team can guide you through the first necessary steps and help you out the rest of the way.
You don’t have to wait any longer before verifying your coverage. Reach out to our team at Nirvana Recovery today for help with starting your confidential coverage checks.
Frequently Asked Questions (FAQs)
Will I Need Pre-Authorization for Rehab With Cigna?
It depends on your specific plan and the level of care you need. Services that may require pre-authorization include:
Inpatient/residential rehab
PHP
IOP
Routine outpatient therapy (weekly individual/group) may not require prior authorization for most Cigna plans.
How Much Will I Have to Pay Out-of-Pocket for Cigna Rehab Coverage?
It depends. Here’s what impacts out-of-pocket costs:
In-Network vs. Out-of-Network: Since in-network providers and facilities have negotiated rates, they cost less than out-of-network.
Deductible: Some plans have separate deductibles for medical services compared to behavioral health.
Out-of-Pocket Maximum: Once you hit your limit, the plan covers 100% of covered services.
How Quickly Can I Start Treatment After Getting Cigna Approval?
As soon as treatment can be provided. It should be within 24-72 hours of Cigna approval. Actual timing may depend on the availability of the facility, level of care requested, and medical clearance.
Cigna Coverage for Drug Rehab in Phoenix Explained
Published On September 22, 2025
Table of Contents
You have perhaps wondered whether you can find quality drug rehab in Phoenix. Finding one significantly increases the chances of long-term recovery and reduces the risk of a relapse or health complications. The quality of care provided and evidence-based treatments used also ease recovery.
Many people are confused about what a Cigna insurance plan covers. This confusion is due to the variety of plan types that have different networks, costs, and rules. This article will provide you with a complete, clear guide to understanding the benefits at your disposal and how to use them.
If you’re considering Cigna coverage or need guidance with your insurance plans, please talk to our team at Nirvana Recovery for help. We are a resource for verifying insurance coverage and helping with treatment planning.
Overview of Cigna Insurance and Addiction Treatment Coverage
About Cigna as a Health Insurance Provider
The Cigna Group is a health service company with its headquarters in Bloomfield, Connecticut. It serves more than 30 countries and jurisdictions, with over 64,000 employees as of 2025. It has more than 2 million relationships with facilities, clinics, and healthcare providers, and over 178 million customer relationships.
Cigna’s commitment to behavioral health services is seen in its partnership with Ginger to provide in-network coverage for on-demand behavioral health coaching, psychiatry, and therapy services. This has reached its 14 million behavioral health customers.
Cigna aims to prevent the early onset of severe mental health conditions through its early access to behavioral health coaching. Coaches are trained to address a wide array of mental health issues and identify the need for higher-level care.
Cigna’s Approach to Substance Use Disorder Treatment
Cigna recognizes addiction as a chronic disease, comparable to diabetes or cancer. It needs to be managed for a lifetime, which is a fact that some people struggle to come to terms with early on.
Cigna believes in helping protect those who may be at-risk and having a healthcare system that supports early detection. It further advocates for the adoption of a new mindset when addressing substance use disorders (SUDs) and avoiding blame words like “abuse.”
Individualized care in its plans helps match patients with the providers who are best suited to address their condition. The Cigna Total Behavioral Health program particularly provides its members access to care navigators who deliver one-on-one personalized assistance. Care navigators help find available providers who can best attend to the individual’s preferences and needs.
Coverage Under the Affordable Care Act (ACA) and Parity Laws
The Affordable Care Act (ACA) has helped make health insurance more accessible and affordable. Since 2014, insurance plans have been required to cover ten Essential Health Benefit categories, one being mental health and substance use disorder services, including behavioral health treatment.
The ACA further mandates small group and individual market plans to treat mental health and SUD services as they would medical and surgical services.
The Mental Health Parity and Addiction Equity Act (MHPAEA) also mandates that health insurers and group health plans must not place more financial requirements, restrictions, or limitations on mental health or SUD services than medical and surgical services. They must be treated equally. This means that a health plan like Cigna should offer benefits that have the same financial requirements and treatment limitations as medical and surgical benefits.
Types of Cigna Plans in Phoenix and What They Cover
Employer-Sponsored Plans
The following are variations in Cigna coverage depending on employer plan tiers:
Individual and Family Plans (Marketplace)
Here’s how network choice impacts costs for Cigna plans in Phoenix:
Cigna Medicare Plans
Cigna offers Medicare plans to meet the needs of seniors and people with disabilities. Let’s have a look at the available options.
Medicare Advantage Plans
Cigna’s Medicare Advantage plans combine the benefits of Original Medicare with additional coverage. Cigna’s Special Needs Plans (SNPs) are designed to provide additional benefits to address the needs of people with specific health needs.
Medicare Supplement (Medigap) Plans
For those who prefer to keep Original Medicare, Cigna provides Medigap plans. They help pay coinsurance, deductibles, and copays. You can also choose any hospital or doctor that accepts Medicare, without requiring referrals (in most cases).
Medicaid Partnerships (If Applicable in Arizona)
Medicaid serves Arizona residents through the Arizona Health Care Cost Containment System (AHCCCS). Cigna offers Dual Special Needs Plans (D-SNPs) designed to coordinate your Medicare benefits with AHCCCS benefits when you’re dually eligible.
Additionally, Cigna provides financial assistance programs to reduce the healthcare costs of eligible individuals. Health insurance subsidies are also available, depending on your household size and income. People who qualify may get a health plan at a lower cost. If you qualify, the two ways you can save money on healthcare plan costs are by getting:
Differences Between HMO, PPO, and EPO Networks
Here’s how different plans differ in their network requirements:
Drug Rehab Services Typically Covered by Cigna in Phoenix
Inpatient and Residential Treatment
Coverage Requirements
Care providers must justify why you need inpatient or residential treatment over a less intensive program. Treatment should be the least intensive level of care that addresses your needs effectively, in line with the American Society of Addiction Medicine (ASAM) principles.
Length of Stay
Cigna doesn’t cap your coverage at a specific number of days, like 30-90 days. Medical necessity determines the length of stay, which is regularly reassessed.
Pre-Authorization
Cigna mandates pre-authorization for inpatient and residential treatment. Care providers must get authorization before starting treatment. Cigna Behavioral Health’s clinical staff is available 24/7 to review and authorize coverage.
Outpatient and Intensive Outpatient Programs (IOP)
Routine Outpatient Treatment
You can have 1-2 sessions per week alone, in group therapy, or for medication management. The sessions are assessed based on clinical need and your treatment plan. Extended or multiple sessions that exceed 50 minutes per session or one session per week are reserved for acute or medically necessary cases. They also require justification.
Intensive Outpatient Program (IOP)
You can get 3-5 days per week, with each session lasting 3-4 hours. This structure is designed to allow you to continue with your regular daily routines.
Partial Hospitalization Programs (PHP)
A partial hospitalization program (PHP) is comparable in intensity to inpatient care. However, you’re allowed to return home at the end of the day. It’s usually used for crisis management or acute symptom reduction.
Cigna requires a one-on-one assessment by a qualified behavioral health clinician 72 hours before admission to a PHP. The evaluation must justify the need for that level of care.
Depending on your plan, Cigna may require pre-authorization for PHP services. Coverage also depends on your plan.
Medication-Assisted Treatment (MAT)
Buprenorphine is part of medication-assisted treatment (MAT). It’s prescribed in outpatient treatment to ease withdrawal, reduce cravings, and support long-term recovery from opioid use disorder (OUD).
Cigna has case managers who can partner with you on MAT to ensure adherence to this covered treatment. The induction phase of treatment and ongoing medication management do not require pre-authorization.
Cigna also covers FDA-approved medications for alcohol use disorder (AUD), like naltrexone, acamprosate, and disulfiram. The exact coverage depends on the specific plan.
Counseling and Therapy
Cigna covers individual, group, and family therapy in all its plans, but the exact access, session frequency, and limits depend on your specific plan.
Aftercare Services
Cigna covers relapse prevention and other ongoing aftercare services that are part of medically necessary treatment for substance use disorders. Such services include:
Coverage and limits depend on your specific plan, medical necessity, and whether the care provider or facility is in-network.
How to Verify Cigna Coverage for Rehab in Phoenix
Review Your Plan Documents
Here’s where you can find behavioral health benefits in your Cigna insurance policy and what you should look for:
Contact Cigna Directly
Here are questions you should ask about coverage, deductibles, and copays:
Use a Rehab Facility’s Insurance Verification Service
Nirvana Recovery can confirm Cigna benefits quickly and accurately on your behalf. Here’s how we do it:
Pre-Authorization Process
Pre-authorization is essential for the following reasons:
Common Challenges with Cigna Rehab Coverage and How to Address Them
Denials and Appeals
The following are common reasons for denied claims:
You can always appeal a denied Cigna claim. Follow these steps:
Out-of-Network Limitations
When a Cigna plan doesn’t include out-of-network facilities, you can’t access services from providers outside the network. If you had reasons for seeking care at out-of-network facilities, this limitation may hold you back.
But there are situations where Cigna may cover out-of-network facilities. They include the following:
Coverage Caps and Limits
The ACA ensures that Cigna doesn’t impose annual or lifetime dollar caps on essential health benefits, such as:
Some optional services may still have annual or lifetime limits, depending on the plan structure. They include elective dental, vision, or cosmetic procedures.
While the ACA prohibits dollar limits, some Cigna plans may include visit limits for some services. For example, it may limit your therapy visits to 60 days per year.
Cigna’s plans also have annual deductibles and out-of-pocket (OOP) maximums, which reset every year. Once you reach your OOP maximum, including deductibles, copays, and coinsurance, the plan starts paying 100% of covered costs.
Why Phoenix Residents Should Consider In-Network Facilities
Cost Savings
Cigna negotiates with in-network facilities and providers to offer care at discounted rates. This lowers your out-of-pocket costs, copays, coinsurance, and deductibles. Upon reaching your OOP maximum, Cigna plans cover 100% of covered services for the rest of the year.
Thanks to the contractual agreement between in-network providers and Cigna, providers or facilities can’t charge you beyond the agreed-upon rate, or what Cigna deems “allowed.” However, they can charge you the balance between what they bill and what Cigna pays.
Seamless Approval
In-network providers are familiar with Cigna’s pre-authorization process and required documentation. Providers in in-network facilities handle the paperwork on your behalf. Their familiarity leads to fewer or no errors and speeds up approvals. Some providers receive notification of approval within days.
Plans that allow you to have a PCP at in-network facilities make processes smoother. Your PCP handles your referrals and manages specialists. Having a PCP reduces confusion and delays.
You also get better outcomes and much fewer delays in programs that make registered nurse care coordinators and Cigna case managers available. They follow up after hospitalization, fill care gaps, and coordinate follow-up treatments.
Examples of In-Network Benefits in Phoenix
In-network benefits include getting local facility types and services covered. Here are the types of in-network facilities and services in Phoenix:
Start Your Rehabilitation with Nirvana Recovery
Navigating Cigna coverage doesn’t have to be stressful. Nirvana Recovery provides resources like this article to make it easy. We understand the complexities you may face, especially when most concepts and terms are new to you. We aim to take away such complexities and provide straightforward comprehension and navigation.
Nirvana has expertise in both mental health and SUD treatment and insurance verification. We know the meeting point of your recovery and insurance needs and make it easy to achieve both. Our admissions team can guide you through the first necessary steps and help you out the rest of the way.
You don’t have to wait any longer before verifying your coverage. Reach out to our team at Nirvana Recovery today for help with starting your confidential coverage checks.
Frequently Asked Questions (FAQs)
It depends on your specific plan and the level of care you need. Services that may require pre-authorization include:
Routine outpatient therapy (weekly individual/group) may not require prior authorization for most Cigna plans.
It depends. Here’s what impacts out-of-pocket costs:
As soon as treatment can be provided. It should be within 24-72 hours of Cigna approval. Actual timing may depend on the availability of the facility, level of care requested, and medical clearance.