Cigna Corporation is a large company that provides numerous services, including health insurance coverage. The corporation generated $195 billion in revenue in 2023, landing it on the list of the top 30 largest businesses in the world based on revenue. Part of the reason for its revenue success is that Cigna also owns Express Scripts, a mail-order pharmacy and pharmacy insurance company.
If you have coverage with Cigna, you may wonder about Cigna mental health coverage.
Does Cigna Cover Mental Health Care?
Most of Cigna’s plans include some type of mental health care coverage. In fact, any insurance plan offered on the health care marketplace has to include behavioral health coverage along the same lines as the physical coverage provided.
Types of services that might be covered by your Cigna plan include:
- Individual, group and family therapy, including cognitive behavioral therapy and other forms of talk therapy
- Inpatient care in a hospital setting or a stand-alone residential facility
- Outpatient care in a clinic, doctor’s office, therapist’s office or other appropriate setting
- Certain testing and assessments that may be required to diagnose a mental health condition or determine an appropriate plan for treatment
- Telemedicine appointments for mental health, including virtual therapy sessions
- Substance abuse treatment, including in inpatient and outpatient settings
- Some medications used to treat mental health conditions
Using Cigna’s Services to Find Health Care
Cigna offers an online directory to help you find providers that take your insurance. You can use the directory to find health care services that work with your plan, whether you purchased the plan on the health care marketplace, have a Cigna Medicare plan or access Cigna coverage through your employer.
You may have received a benefits book when you signed up for your plan. There may be a list of local providers in that book that are in network with your plan. You can also call the customer service line for your plan — this phone number is usually on your insurance card — and ask about available providers in your area.
It’s important to work with an in-network provider when possible to reduce your out-of-pocket costs. Typically, insurance companies such as Cigna pay in-network bills at a higher percentage than they do bills from out-of-network providers. For example, you might owe coinsurance of 10% or 20% with in-network providers, while you’d owe 40% or more if you went with an out-of-network provider.
How Mental Health Care Providers Can Check Your Coverage Before You Commit to Care
When you’re dealing with a mental health crisis, you may not have the time or presence of mind to sort through coverage directories or benefits paperwork. That’s okay. It’s more important to reach out for assistance from a potential provider than to get the details right — mental health providers can help you do that by checking your coverage so you know the financial outlook before committing to care.
Understanding Insurance Verification
When you connect with a potential mental health provider for inpatient or outpatient care, they typically conduct an insurance verification. They ask for information from your insurance card, including member name and ID number. You may need to provide a copy of the front and back of the card to a potential provider.
Using that information, mental health providers confidentially check your coverage. This is known as an insurance verification. When they conduct the verification, they find out:
- What type of mental health care your insurance plan covers
- Whether the provider in question is in-network
- What your deductible and co-pays might be
A prospective mental health provider explains all this information so you can make an educated decision about your care. If your Cigna therapy coverage or other benefits don’t work with a specific provider, they can recommend other options or refer you to a different provider.
Deductibles, Co-Pays and Out-of-Pocket Expenses
During a Cigna behavioral health coverage verification, a mental health provider may ask about your deductible. They’ll find out the total deductible and, potentially, whether you’ve met any of it yet. This can help you understand how much of the cost of care you may owe.
For example, if you have a deductible of $6,000 for your plan and you’ve already had $4,000 in medical expenses this year, you may need to pay for $2,000 of mental health care before your insurance begins to pick up the bill.
In some cases, you may owe a co-pay amount. For instance, if your plan covers doctors’ appointments at 80% and you see a medical doctor for medication for depression or anxiety, you may need to pay 20% of the allowed amount for that office visit.
Every plan offers different levels of coverage, and the way deductibles and co-pays work can differ depending on the type of service you need. A comprehensive insurance verification is the best way to understand where you stand and whether your insurance plan will cover potential treatment.
Get Help Getting Help With the Mental Health Hotline
If you aren’t sure what resources might be right for your needs and you’re struggling to understand your insurance benefits, don’t let that stop you from seeking assistance. You can start with a resource such as the National Mental Health Hotline. Reach out 24-7 to get free and confidential guidance to help you connect with providers and other mental health resources in your area.
