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A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
If you are unable to use electronic prior authorization, you can call us at 800.88Cigna (882.4462) to submit a prior authorization request. For Inpatient/partial hospitalization programs, call 800.926.2273. Submit the appropriate form for outpatient care precertifications. Visit the form center.
For Medical Services Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request.
Many health plans protect patients against off-label use of Ozempic or Mounjaro to help control weight. For example, part of Cigna Healthcares coverage criteria for Ozempic requires that patients have been diagnosed with type 2 diabetes and have tried metformin without success, when appropriate.
Our standard response time for prescription drug coverage requests is 5 business days. If your request is urgent, it is important that you call us to expedite the request. View our Prescription Drug List and Coverage Policies online at cigna.com.
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The prior authorization process can range from a few days to a few weeks. This can depend on the urgency of getting the medication, the speed of the provider and insurance communicating, and the complexity of completing all the required steps.
How does the prior authorization process work? Typically, within 5-10 business days of receiving the prior authorization request, your insurance company will either: Approve your request. Deny your request.
 Complete this section only if someone other than the covered person is appealing.  The covered person may represent himself, or may ask another person, including the. treating health care provider, to act as the authorized representative.

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