Edit: It looks like this was my deductible. It looks like I didn't fully understand how things were billed before/after my deductible was met. Thanks for the help everyone! I recently received a bill for $275 from an in-home sleep study. When looking at my EOB it says that the ammount billed was $450 and Cigna negotiated a $175 cost reduction, however under "What Cigna Plan Paid" the amount is listed as $0. Also, the provider network status is listed as "IN NETWORK". I was operating under the assumption that this at home sleep test would fall under the other lab work from an independent lab category and would be billed at 15%. Not sure if this is necessary info, but I am located in California. My questions are: 1. Does anyone know what an in-home sleep study would be classified as when it comes to how it is billed? 2. Is it possible to contest this with Cigna to get them to cover more? 3. Is it possible to negotiate this bill with Virtuox in the event that Cigna will not budge?

I’m really hoping someone who works in medical billing at a dentist office can help me understand this. For context, I have Cigna Dental PPO. I had an oral consultation today that cost $167. The oral surgeon said I definitely need the bottom ones removed, but said she isn’t worried about the top ones. Then here is an image of what I was quoted after. They said I would either be paying $5809 or $3789 depending on what my insurance says. She didn’t sound confident in what she was saying and was speaking to someone else prior. Then, they tried to make me schedule it with 50% down as if I have $1800-2900 just laying around. I could barely afford the consultation fee. I’m I being got or is this how much people are paying to get their wisdom teeth removed? I’m so lost…

Hi All, I'm hoping you can help me review my options and come up with a plan for a recent unexpected (and I believe inaccurate) medical bill. I get annual cleanings and other routine dental care (e.g. 1 set of x-rays a year) for free under my dental plan. I have just recently gotten off of my parent's insurance and onto my own plan so I made sure to double and triple check both on my insurance provider (Cigna)'s website and on Zocdoc that I was booking an in-network appointment. At my appointment, however, I was seen by a different dentist than the one I booked with who ended up being an out-of-network dentist. I was surprised by a $400 bill from Cigna, which should have been $0, several weeks later. A fruitless chat with a Cigna rep led to them reprocessing my claim, even though I knew it wouldn't do any good since the information submitted by the dental office showed that I was seen by the out-of-network dentist. A week ago the claim was processed and my bill went up to nearly $1000 because they say the facility is out of network. It is not, and I have a screenshot from Cigna's website showing it isn't. Anyway, I'm feeling a bit lost about how to proceed. I know about the No Surprises act but am not totally sure how I would go about using it to my advantage here -- I do have the original emails showing that I booked my appointment with a different provider than the one who saw me, but am not sure how I can communicate this to the right people. Any advice about next steps would be very much appreciated! TIA for helping me figure out how to move through this. EDIT: In my 20s, live in NY State, insured through employer.

My wife recently had sinus surgery, and we paid a $3,000+ hospital bill before the surgery as they said she couldn’t have the procedure without paying it. That covered the rest of her OOP max. Cigna still hasn’t processed the claim two months later, and meanwhile other bills and late fees are stacking up because her OOP max isn’t shown as being met. We contacted Cigna and they said it finally processed last week (not reflected on their website) and that we need to allow 21 days for it to go through. How do we handle this with other providers calling and threatening additional late fees? My wife wants to pay but I think we should wait for the claim to go through.

My family has Cigna through my husband’s employer. About two months ago I felt like I had the flu, and couldn’t get in with my PCP until the following week. Was told I should try go to urgent care for a flu test and to get checked out. I did, and was in and out in about 30 minutes (flu A positive, sent on my way with some meds). A few weeks later, I get a bill for almost $400 and was shocked. A month later, my son ended up getting rushed to the ER. We were there for about 7 hours under observation after getting some initial meds…. And I just got the bill for that. $150 copay, that’s it. Looked up our coverage with Cigna. It states ER visits have a $150 copay with the deductible waived. For urgent care, it says “after the in-network deductible is met, you pay 10%”. In what world is this right? I thought the whole point of an urgent care was to try to alleviate the stress on ERs. I feel like now I have no reason to ever go to an urgent care… even if all I need is a simple strep test or have UTI symptoms. Is this becoming the norm?

Cigna denied my claim for a “periodic oral evaluation-established patient”, but approved adult cleaning (two per calendar year). This was the second examination and cleaning I got in the year. Reason for denial is “N4 - This claim is denied due to lack of information. If you would like to have the claim reconsidered, please submit the information requested” I contacted Cigna customer service twice and both agents said they didn’t know what the information requested was and provided no course of action. Who can I reach out to to understand what additional information is requested since Cigna doesn’t know?

My husband has a herniated disc and possibly arthritis, and we’ve been putting off going to the doctor because we’re confused and stressed about what our insurance (Cigna Wellfleet Student) will actually cover. We’re in Rhode Island. From what we can see, the MRI isn’t fully covered under our plan, and possibly other services aren’t either. A regular doctor visit would cost us about $50 out-of-pocket (not sure about the exact term), which isn’t awful, but feels kind of pointless if we can’t afford to get the necessary tests like MRIs anyway. What’s really throwing us off is that a friend of ours, another student with the *same exact plan*, broke their foot, went to the ER, got an MRI and whatever else was needed, and only ended up paying $100 for the ER visit. That’s it. We’re super confused. We’re also hesitant to call the insurance company because we’re scared they’ll be vague or misleading on purpose, or try to hide what’s actually covered to benefit themselves. We feel really stuck and just want to make the best decision for his health without going broke. Has anyone had experience with Cigna Wellfleet Student plans, especially in RI? Any advice on how to navigate this or what we can do to get clearer answers?

My wife has started seeing a new therapist who she seems to really like. The therapist is out of network for our insurance (Cigna) and I think does only self-pay, but issues a superbill at the end of the month that we can submit for reimbursement. This superbill contains her NPI number but not her TIN. I have submitted claims with these superbills to Cigna but they have been denied due to lacking a TIN. After seeing the denials I googled and found that this provider is a sole proprietor therefore her TIN is actually her SSN, and that it is a relatively common practice for solo therapists to be structured this way instead of through an LLC. If she declines to provide a TIN to our insurance company is our only recourse finding a different provider? I’m not going to ask my wife to switch but just want to understand the lay of the land.

Last month, I was laid off. I opted into COBRA with a start date of 04/01. The paperwork was sent to me last Wednesday, I elected into it Thursday, and paid my premium on Friday. Today, I logged into Cigna and it's showing I'm inactive with no insurance. After a few hours of customer service between the COBRA intermediary (WageWorks), they assured me I'm active and it takes a couple of weeks for Cigna to process. They sent things over yesterday and said my insurance would be dated 04/01. On the chat, Cigna wasn't able to help very much (which I understand). Is there anything else I should work on during this transitional time? Or, have others had success with waiting and letting the process work itself out? Thank you all so much!

My husband works for a company headquartered in Virginia, though around 1/4 of their staff are in NC. They recently switch their health insurance from Cigna to Sentara, which I’m sure is great for the Virginia folks but our nearest in network hospital is now a 1.5 hour drive from here. This seems like it would violate some sort of MEC requirement? But I don’t know enough to know and my husband has not been able to get in touch with HR for answers.