What is the process for appealing a denied claim?

When dealing with a denied claim from CIGNA HealthSpring, it is important for members to understand the process for appealing the decision. Initially, the member should review the Explanation of Benefits statement that accompanies the denial to identify the reasons for the denial. This document provides important details about the claim's status and the policy provisions that were cited. To initiate the appeal, the member must generally submit a formal written request to CIGNA HealthSpring. This request should include relevant information such as the member's identification details, the specific claim in question, and any supporting documentation that may strengthen the case for reconsideration. It may also be beneficial to include a personal statement explaining why the claim should be approved. CIGNA HealthSpring typically has a specific timeline for appealing a claim, and members should ensure that their appeal is submitted within that timeframe. Once the appeal is received, CIGNA HealthSpring will review the case and respond, often within a set period, informing the member of the outcome. For the most accurate guidance and details about the appeal process, it is advisable to check the current web page for relevant policies and procedures.