Urgent Care Claim
If you are requesting pre-certification of an Urgent Care
Claim, the time deadlines are different. The Claim
Administrator will respond to you and/or your doctor
with a determination by telephone as soon as possible,
taking into account the medical exigencies, but not later
than 72 hours after receipt of the claim. The determination
will subsequently be confirmed in writing.
If you improperly file an Urgent Care Claim, you will be
notified of the proper procedures as soon as possible but
not later than 24 hours after receipt of the claim. Unless the
claim is resubmitted properly, it will not constitute a claim.
If an Urgent Care Claim is received without sufficient
information to determine whether or to what extent
benefits are covered or payable, the Claim Administrator
will notify you and/or your doctor as soon as possible,
but not later than 24 hours after receipt of the claim, of
the specific information necessary to complete the claim.
You and/or your doctor will have 48 hours to provide the
specified information. If the information is not provided
within that time, your claim will be denied.
Note: Claims involving Urgent Care (as defined) must be submitted by telephone to the applicable vendors
(CIGNA, Cigna Behavioral Health or Caremark®) at the number listed on the back of your ID card.
