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Click ‘Get Form’ to open the Cigna Network Exception Request in the editor.
Begin by entering the 'Date of Request' at the top of the form. This helps track when the request was made.
Fill in the 'Customer Name', 'Date of Birth', and 'Cigna Member's U# / ID#'. Ensure accuracy as this information is crucial for identification.
Provide the 'Outpatient Provider Name' along with their degrees, independent license, and TIN. This section verifies the provider's credentials.
Indicate the 'Requested start date for NER' and any previous authorization numbers if applicable. This helps in processing renewals efficiently.
Detail the diagnosis using F codes and list requested CPT codes. Be specific to avoid delays in approval.
In the clinical rationale section, clearly outline primary issues being treated and any specialties that will be delivered by the provider.
Finally, provide any additional relevant information before signing and saving your completed form. Remember to email it to NER@cigna.com or fax it to 860-687-7329.
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To obtain an exception, your Physician may call Cigna Healthcare, or complete the appropriate form and fax it to Cigna Healthcare to request an exception.
Why are doctors dropping Cigna?
Youre only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
What is a network exception form?
Requesting a network gap exception from your health insurer is formally asking the insurer to cover care you get from an out-of-network provider at the in-network rate. The insurer considers these requests on a case-by-case basis.
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