Yes, Cigna may reimburse out-of-network therapy, but only if your specific plan includes out-of-network benefits—and you’ll generally pay more out of pocket compared to in-network care. Understanding your Cigna plan’s coverage for therapy outside their provider network is crucial if you want flexibility in choosing your therapist or need specialized care.
Knowing if—and how—Cigna covers out-of-network therapy can help you avoid surprise bills, make informed decisions, and get the most out of your mental health benefits. This guide explains the key requirements, steps to file a claim, what Cigna pays, and the latest policy details.
What Does “Out-of-Network” Therapy Mean?
“Out-of-network” (OON) therapy means receiving care from a therapist who is not contracted with Cigna. These therapists set their own rates, and Cigna may only cover a portion of the cost—if your plan allows it.
Why Does This Matter?
- Higher out-of-pocket costs: You may face higher deductibles and coinsurance.
- Limited reimbursement: Cigna pays only up to a certain “allowed amount.”
- Possible balance billing: You could owe the difference between your therapist’s fee and Cigna’s reimbursement.
- Claim submission required: You or your therapist must submit a claim to get reimbursed.
Which Cigna Plans Cover Out-of-Network Therapy?
Not all Cigna plans include out-of-network coverage.
Here’s what you need to know:
- PPO (Preferred Provider Organization): Usually includes out-of-network benefits, but at a higher cost than in-network.
- POS (Point of Service): May offer out-of-network coverage—check your policy.
- Indemnity Plans: Typically allow you to see any provider, with partial reimbursement.
- HMO & EPO Plans: Usually do not cover out-of-network therapy except for emergencies.
Always check your plan’s Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC) document.
- Log in to your myCigna account or call Cigna’s customer support for help finding your policy details.
- Official Cigna guide on in-network vs. out-of-network.
How Does Cigna Reimburse Out-of-Network Therapy?
1. Allowed Amount & Cost Sharing
Cigna sets an “allowed amount” for out-of-network services. This is often much less than what your therapist charges.
- You pay:
- Out-of-network deductible (usually higher than in-network)
- Coinsurance (a percentage of Cigna’s allowed amount, often 30–50%)
- Any difference between allowed amount and therapist’s actual fee (“balance billing”)
- Cigna pays: Their share of the allowed amount, once your deductible is met.
Example:
Therapist charges: $200/session
Cigna’s allowed amount: $120
Your coinsurance: 40%
You pay: $48 (coinsurance) + $80 (balance billing) = $128/session
Cigna pays: $72/session
Always confirm the allowed amount with Cigna before starting therapy!
2. Claim Submission
- You (or your therapist) must submit a claim using a CMS-1500 or UB-04 form.
- Claims must be filed within 180 days of your session date (Cigna claims info).
- After review, Cigna will send you an Explanation of Benefits (EOB) and, if approved, a reimbursement check or direct deposit.
Prior Authorization, Limits, and Recent Policy Updates
- Prior Authorization: Some mental health services may require approval before treatment. Check with Cigna to avoid denied claims.
- Session Limits: There may be yearly limits on reimbursable therapy visits—always confirm with your plan.
- Recent Updates: some ACA marketplace and employer plans have expanded telehealth and mental health coverage, but out-of-network benefits still vary by plan (NAMI, 2025).
- No Surprises Act: New regulations help protect against surprise billing, but out-of-network mental health billing can still leave you responsible for significant costs (CMS, 2025).
Steps to Get Reimbursed for Out-of-Network Therapy with Cigna
- Confirm Coverage
- Check your plan details for out-of-network mental health benefits.
- Get an Itemized Receipt
- Make sure your therapist provides a “superbill” or detailed invoice.
- Submit Your Claim Promptly
- File online, by mail, or via fax—use Cigna’s claim forms.
- Track Your Claim
- Log in to myCigna to monitor your claim status and view EOBs.
- Appeal if Denied
- If Cigna denies your claim, you have 180 days to file an appeal (official Cigna appeals info).
Frequently Asked Questions (FAQ)
Does Cigna cover teletherapy out-of-network?
If your plan allows out-of-network therapy, telehealth sessions are generally eligible—check your plan’s mental health telehealth benefits.
How much will Cigna reimburse for out-of-network therapy?
It depends on your plan’s “allowed amount,” your deductible, and coinsurance rate. You’ll usually pay more than in-network.
Can my therapist submit the claim for me?
Yes, many licensed therapists can bill Cigna directly for you, but if not, you must submit the claim yourself.
Conclusion
Cigna will reimburse out-of-network therapy only if your plan covers it—and you follow their requirements for claims, receipts, and deadlines. Check your policy today, confirm the allowed amounts, and don’t hesitate to ask Cigna member services for guidance.