Cigna
This guide will help you understand how Cigna covers mental health and substance use disorder treatment so you can focus on your recovery journey.
When facing mental health challenges or substance use disorders, knowing your insurance coverage is essential for accessing appropriate care without unnecessary financial strain. Cigna provides comprehensive behavioral health coverage as part of their commitment to whole-person health.
Under the Affordable Care Act (ACA), all health insurance marketplace plans, including those offered by Cigna, must cover mental health and substance use disorder services as essential health benefits. This legislation ensures that mental health and substance use disorder treatments receive coverage comparable to medical and surgical benefits—a concept known as mental health parity.
Mental health conditions are treated just like any other medical condition, meaning Cigna cannot deny you coverage because you have a mental health condition, and they cannot refuse to cover care for any diagnosed condition.
Cigna's approach to behavioral health recognizes the connection between physical and mental wellbeing. Their mental health coverage is typically included under your medical plan with no separate deductible, making it easier to access care when you need it. Behavioral health benefits are administered by Evernorth Behavioral Health, Inc., a Cigna subsidiary specializing in mental health and substance use disorder services.
Types of Cigna Plans and Mental Health Coverage
Cigna offers several types of health insurance plans, each with different approaches to mental health coverage:
HMO (Health Maintenance Organization) plans typically require you to choose a primary care physician who coordinates your care and provides referrals to specialists. For mental health services, you may need a referral from your primary care provider before seeking treatment.
PPO (Preferred Provider Organization) plans offer more flexibility, allowing you to see both in-network and out-of-network providers, though costs are usually lower when staying in-network. These plans typically don't require referrals to see specialists, including mental health providers.
EPO (Exclusive Provider Organization) plans don't require referrals to see specialists, but like HMOs, they only cover services from in-network providers. With these plans, you typically don't need a referral from your primary care physician to access mental health services.
Bronze, Silver, Gold, and Platinum Plans offer different levels of cost-sharing. Bronze plans have lower monthly premiums but higher out-of-pocket costs (you pay 40%, Cigna pays 60%); Silver plans have moderate premiums and cost-sharing (you pay 30%, Cigna pays 70%); Gold plans have higher premiums but lower cost-sharing (you pay 20%, Cigna pays 80%); and Platinum plans have the highest premiums but lowest out-of-pocket costs (you pay 10%, Cigna pays 90%).
Understanding your specific plan type is essential as it determines which providers you can see, whether you need referrals, and how much you'll pay out-of-pocket for services.
Mental Health Services Covered by Cigna
Cigna generally covers a wide range of mental health and substance use disorder services. While specific coverage details may vary by plan, commonly covered services include:
Outpatient Services
Cigna typically covers various outpatient mental health services, including individual therapy with licensed providers, psychiatric evaluations and medication management, group therapy sessions, and psychological testing. Many plans also cover intensive outpatient programs (IOPs) that provide structured treatment several days per week (typically 15-20 hours) while allowing patients to maintain their daily routines.
Inpatient Services
For more acute mental health needs, Cigna generally covers inpatient services such as hospitalization for mental health crises, residential treatment programs, partial hospitalization programs (PHPs), and detoxification and rehabilitation services for substance use disorders. Partial hospitalization programs typically involve 25-30 hours of treatment per week without overnight stays, providing intensive care while allowing patients to return home in the evenings.
Additional Support Services
Cigna's behavioral health coverage also includes support for co-occurring disorders (dual diagnosis), where a person has both a mental health condition and a substance use disorder. This integrated approach ensures comprehensive treatment addressing all aspects of a person's health. Additionally, Cigna covers medication management, with prescription coverage typically organized in tiers (Tier 1 for generics, Tiers 2 and 3 for preferred and non-preferred brand-name drugs).
Common Mental Health Conditions Covered
Cigna plans generally cover treatment for a wide range of mental health conditions and substance use disorders, including:
Depression and mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, eating disorders, substance use disorders, attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and dual diagnosis (co-occurring mental health and substance use disorders).
It's important to note that Cigna typically only covers traditional, evidence-based therapies like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Alternative therapies such as music therapy, art therapy, or acupuncture may not be covered unless they're part of an approved treatment plan and deemed medically necessary.
Verifying Your Cigna Mental Health Benefits
Before seeking treatment, it's important to understand your specific coverage details to avoid unexpected costs and ensure you can access the care you need. Here are steps to help you verify your benefits:
Review your plan documents: Look for information about behavioral health or mental health coverage in your Summary of Benefits document. This outlines coverage details, limitations, and requirements for mental health services.
Log into your Cigna account: Access your online account through myCigna.com or the Cigna app to view your specific plan details, including coverage information for behavioral health services.
Check provider network status: Verify if your preferred mental health provider is in-network using Cigna's online provider directory or by calling the provider directly with your insurance information. Staying in-network typically results in lower out-of-pocket costs.
Understand your financial responsibility: Mental health services usually require cost-sharing in the form of:
Copayments: Fixed amounts paid at the time of service
Coinsurance: Percentage of costs you pay after meeting your deductible
Deductibles: Amount you pay before Cigna begins covering services
For personalized benefit information, call the Member Services or Behavioral Health number on your Cigna ID card. Representatives can provide detailed information about your specific coverage and help you find appropriate providers.
Authorization Requirements for Mental Health Treatment
Many mental health services under Cigna plans require prior authorization, especially for higher levels of care. Understanding these requirements can help avoid coverage denials and unnecessary expenses.
Services That Typically Require Prior Authorization
Cigna typically requires prior authorization for inpatient hospitalization, residential treatment programs, partial hospitalization programs (PHPs), and intensive outpatient programs (IOPs). The authorization process helps ensure that these services are medically necessary and appropriate for your condition.
For emergency mental health services, prior authorization is not required. If you believe you're experiencing a life-threatening emergency, you should go directly to the nearest emergency facility or call emergency services. Cigna will cover emergency services regardless of whether the provider is in-network.
Authorization Process
The authorization process for non-emergency services typically involves:
Initial assessment: A qualified provider evaluates your condition and recommends appropriate treatment.
Provider submission: For services requiring authorization, your provider submits clinical information to Cigna justifying the medical necessity of requested services.
Review and determination: Cigna reviews the information and makes a coverage decision based on medical necessity guidelines. This determination considers the appropriate level of care based on your specific needs.
Ongoing review: For continuing services like inpatient care, Cigna may conduct concurrent reviews to assess continued need for the level of care.
In-network providers are familiar with Cigna's authorization requirements and typically handle this process for you. For out-of-network providers (if your plan includes out-of-network coverage), you may need to be more involved in securing authorization. Always check your plan documents for specific authorization requirements, as they can vary between different Cigna plans.
Finding Cigna In-Network Mental Health Providers
Staying in-network typically results in lower out-of-pocket costs and smoother insurance processing. Finding quality providers who accept your Cigna plan is crucial for accessing affordable mental health care.
There are several ways to find in-network mental health providers:
Use Cigna's online directory: Log in to myCigna.com or use the Cigna app to search for behavioral health providers in your area who accept your specific plan.
Call Cigna's customer service: Contact the number on your Cigna ID card and ask for assistance finding in-network mental health providers who specialize in your specific needs.
Ask for recommendations: Your primary care physician may be able to recommend mental health providers who accept Cigna insurance.
Our treatment directory offers a comprehensive selection of quality mental health and addiction treatment providers who accept Cigna insurance. These facilities have been vetted for their expertise in treating various mental health conditions and substance use disorders, ensuring you receive effective care from experienced professionals. Using our directory simplifies the process of finding appropriate care that's covered by your Cigna plan.
When searching for providers, consider factors beyond network status, such as experience with your specific condition, availability of appointment times, treatment approaches and specialties, and location accessibility.
Managing Out-of-Pocket Costs for Mental Health Care
Even with insurance coverage, you may have financial responsibility for some mental health treatment costs. Understanding and planning for these expenses can help make treatment more accessible.
Typical Out-of-Pocket Expenses
When using your Cigna coverage for mental health services, your costs will depend on your specific plan, but typically include:
Copayments: Fixed amounts (often $15-$50 for in-network therapy sessions) paid at the time of service
Coinsurance: Percentage of costs you pay after meeting your deductible, which varies based on your plan level (Bronze: 40%, Silver: 30%, Gold: 20%, Platinum: 10%)
Deductibles: Amount you pay before Cigna begins covering services
Out-of-network charges: Higher costs when seeing providers outside your plan's network
Cost Management Strategies
To manage your mental health care costs effectively:
Stay in-network whenever possible, as Cigna has negotiated lower rates with these providers
Understand your plan level (Bronze, Silver, Gold, or Platinum) and the associated cost-sharing
Verify coverage details before starting treatment to avoid surprise bills
Ask about sliding scale fees or payment plans if you're concerned about costs
Check if your employer offers an Employee Assistance Program (EAP) that might provide initial counseling sessions at no cost
Remember that investing in mental health treatment now can help prevent more costly interventions later and improve your overall quality of life and functioning.
Unique Features of Cigna Mental Health Coverage
Centers of Excellence Program
Cigna has established a Centers of Excellence designation for facilities that demonstrate the best patient outcomes and cost efficiency. These include specialized centers for substance use treatment, mental health care, eating disorders, and child and adolescent mental health. By choosing a Center of Excellence, you can be confident you're receiving high-quality care from providers who meet Cigna's rigorous standards for clinical excellence and patient outcomes. This program helps guide members toward facilities with proven track records of success in treating specific conditions.
Comprehensive Case Management
Cigna offers dedicated case management services for members requiring hospitalization or intensive treatment for mental health or substance use disorders. Care managers coordinate services during treatment and ensure safe and effective transitions after discharge. This personalized support helps navigate the complexities of the mental health care system, ensures continuity of care between different levels of treatment, and addresses any barriers to recovery. Case managers can also connect members with community resources and ongoing support to maintain progress after formal treatment ends.
How to Determine if Your Specific Cigna Plan Covers Needed Treatment
Mental health coverage can vary significantly between different Cigna plans. To determine if your specific plan covers your needed treatment:
Check your plan documents: Your Summary of Benefits document outlines your specific coverage details for behavioral health services, including any limitations or exclusions.
Contact Cigna directly: Call the Member Services or Behavioral Health number on your Cigna ID card for personalized information about your coverage for specific treatments.
Speak with your provider: Mental health professionals familiar with Cigna can often help interpret coverage for specific treatments and may assist with the authorization process.
Use the myCigna portal or app: Log in to your online account to verify coverage details, check in-network providers, and learn about any authorization requirements.
Remember that coverage determination is based on medical necessity as well as your specific plan benefits. Cigna typically covers treatments that are evidence-based and considered medically necessary for your diagnosed condition. However, they may not cover experimental treatments, luxury rehabilitation facilities, or services deemed not medically necessary.
Benefits of Choosing a Facility That Accepts Cigna
Selecting a treatment facility that accepts Cigna insurance offers several advantages:
Lower out-of-pocket costs: In-network facilities have negotiated rates with Cigna, resulting in lower costs for members.
Streamlined billing: In-network providers handle insurance claims directly with Cigna, reducing administrative burden during an already stressful time.
Simplified authorization process: In-network facilities are familiar with Cigna's authorization requirements and typically handle most of this process for you.
Coordinated care: Cigna's case management programs can work more effectively with in-network facilities to ensure comprehensive treatment.
Quality assurance: Facilities in Cigna's network, especially those designated as Centers of Excellence, meet certain standards for quality of care.
Find Treatment Centers That Accept Cigna Today
Ready to take the next step? Browse our directory of treatment facilities that accept Cigna insurance to find the right match for your needs. Our comprehensive listings include information about services offered, treatment approaches, and location details to help you make an informed decision.
Don't let insurance concerns delay your path to wellness. With the right coverage information and support, you can access the care you need to begin your recovery journey.
References
[2] https://www.cigna.com/knowledge-center/mental-health-care
[3] https://www.cigna.com/knowledge-center/treatment-for-substance-use-disorders
[4] https://www.cigna.com/employers/behavioral-health/