Level One Appeal
Your appeal will be reviewed and the decision made by someone not involved in the initial decision. Appeals
involving Medical Necessity or clinical appropriateness will be considered by a health care professional.
Level Two Appeal
If you are dissatisfied with our level one appeal decision, you may request a second review.
Independent Review Procedure
If you are not fully satisfied with the decision of Cigna's level two appeal review regarding your Medical Necessity or clinical appropriateness issue, you may request that your appeal be referred to an Independent Review Organization. The Independent Review Organization is composed of persons who are not employed by Cigna HealthCare or any of its affiliates. A decision to use the voluntary level of appeal will not affect the claimant's rights to any other benefits under the plan.
There is no charge for you to initiate this independent review process. Cigna will abide by the decision of the Independent Review Organization.
In order to request a referral to an Independent Review Organization, certain conditions apply. The reason for the denial must be based on a Medical Necessity or clinical appropriateness determination by Cigna. Administrative, eligibility or benefit coverage limits or exclusions are not eligible for appeal under this process. To request a standard external review, you or your authorized representative must file a written request for an external review with the Arkansas Insurance Commissioner within four (4) months after the date of receipt of a notice of adverse determination. Requests for expedited external review may be made orally or in writing to the Arkansas Insurance Commissioner within four (4) months after the date of receipt of a notice of adverse determination