How to appeal a denial from Cigna

UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE

Cigna Healthcare focuses heavily on employer-sponsored coverage, with pharmacy benefits usually managed by Express Scripts (part of Cigna's Evernorth). Many Cigna employer plans are self-funded — meaning Cigna administers the plan but your employer funds it — which changes which external-review rules apply to you.

How appeals work at Cigna

• Appeals can generally be started from the claim detail in myCigna or by mail to the address in the letter's appeal-rights section.
• Prescription denials usually run through Express Scripts with their own exception/appeal instructions on the notice.
• Because many Cigna plans are self-funded employer plans, check your letter or summary plan description: self-funded (ERISA) plans use the federal external review process rather than your state's program.
• Your HR or benefits team can tell you if the plan is self-funded — and for self-funded plans, the employer's plan administrator sometimes has discretion worth appealing to directly.

The deadlines that apply to nearly every Cigna plan

• At least 180 days to file the internal appeal from the date on the denial notice (non-grandfathered plans; the date printed on your letter controls).
• The plan must decide within about 30 days for care you haven't received yet, and about 60 days for care already received.
• Urgent case? Ask for an expedited appeal — a decision in roughly 72 hours when a physician confirms that waiting endangers your health.
• After the final internal denial: you can request independent external review — generally within about 4 months, per your letter.
• Employer self-funded plan? ERISA rules apply: state programs and regulators generally don't, and external review runs through the federal process. Your letter or HR can confirm the funding type.

Federal sources: HealthCare.gov internal appeals and HealthCare.gov external review. Your denial notice and plan documents control when they differ.

Best next reads: Out-of-network denials and Formulary / drug-not-covered denials — and decode any codes on the letter in the denial-code library.

Common questions

How do I know if my Cigna plan is self-funded, and why does it matter?

Ask HR or check the summary plan description; denial letters often state it. Self-funded plans are governed by federal ERISA rules — state external-review programs and state insurance regulators generally don't apply, and your independent review runs through the federal process instead.

Where do I appeal a prescription denial on a Cigna plan?

Usually to Express Scripts, Cigna's pharmacy benefit manager — the denial notice names the right process. Your prescriber can also file a formulary exception with supporting clinical notes, which is often the faster path.