Cigna Denials per their Reimbursement Policy
Is anyone seeing denials from Cigna where they determine that certain billed charges do not meet the criteria for payment according to the hospitals agreement with Cigna.They refer to Cigna Reimbursement Policy which can be found on their website: R14; R12; R09 and R16? Example: They do not want to pay for drugs used in the operating room and they reference Cigna Policy R12. If you go to the website you will find that policy R12 states that routine service or supplies not separately billable - inclusive in operating room charge per Cigna policy R12. Need suggestions on how to fight these denials. I am currently filing a level 1 appeal with Cigna and supplying them with a line item spreadsheet along with documentation from the medical record to support each denied supply/services. The typical response from Cigna is "After reviewing your request, we have decided to uphold the original decision" Any and all suggestions on how to handle these denials would be greatly appreciated.
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