Cigna MA

Contract: H5416 · Plan type: HMO

Evidence lead: Ranks seven through ten · High appeal-filing share

Cigna MA: Appeals followed a large share of denials

3,524 appeals equal 15.0% of this contract's recorded denials. That is rank #8 of 37 for filing share. The ratio reports aggregate activity; it cannot reveal why an appeal was or was not filed, whether the underlying cases were comparable, or what happened outside the reporting window.

Ranks seven through ten · High appeal-filing share

Appeals followed a large share of denials

3,524 appeals equal 15.0% of this contract's recorded denials. That is rank #8 of 37 for filing share. The ratio reports aggregate activity; it cannot reveal why an appeal was or was not filed, whether the underlying cases were comparable, or what happened outside the reporting window.

Ranks seven through ten · Large request-volume cohort

One of the ten largest authorization workloads

The 290,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #10 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks eleven through fifteen · Upper-middle denial cohort

Above the center of the denial-rate ordering

The recorded 8.1% denial rate falls in the upper-middle portion of the contract set. The exact rank is #14 of 37. This is aggregate prior-authorization activity for the reporting window, not a probability that a particular service, drug, or beneficiary request will be denied.

Ranks sixteen through twenty · Upper-middle reversal reach

Reversals covered an above-median share of denials

Overturned appeals represent 10.5% of all denials here, based on 2,466 reversals. The cross-contract rank is #20 of 37. This derived measure combines appeal filing and outcome, so it supplies scale context but does not identify clinical reasons, administrative errors, or coverage rules.

Ranks sixteen through twenty · Upper-middle overturn cohort

Appeal overturns ran above most contracts

The observed overturn rate is 70.0%, in the upper-middle portion of the table. Its overturn-rate rank is #19 of 37. The denominator is filed appeals, not all authorization requests. The percentage therefore describes reviewed appeals and must not be read as an individual outcome forecast.

Prior Authorization Scorecard

PA Requests
290,000
PA Denial Rate
8.1%
Appeals Filed
3,524
Appeal Overturn Rate
70.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 290,000
PA Approved 266,510
PA Denied 23,490
Appeals Filed 3,524
Appeals Overturned 2,466
Source: CMS Office of Inspector General report OEI-09-22-00380; KFF 2023 Medicare Advantage analysis. Verify with HHS OIG → · CMS.gov →
Sources, caveats, and related notes for Cigna MA
What does Cigna MA's overturn rate mean? Of the appeals filed after denials in this source record, 70% were overturned (2,466 of 3,524 filed appeals, not all 23,490 denied requests).
This data is for informational purposes only and does not constitute medical, financial, or insurance advice. Contact CMS or your plan for coverage decisions. Data from CMS OIG and KFF Medicare Advantage analysis.

Data: CMS OIG OEI-09-22-00380 and KFF 2023 Medicare Advantage analysis. Not affiliated with CMS. ← All MA plans

Read our methodology - how this data is sourced, computed, and verified.

Primary data: U.S. Department of Health & Human Services, Office of Inspector General, Medicare Advantage Encounter Data (Report OEI-09-22-00380, 2024). Secondary data: Kaiser Family Foundation 2023 Medicare Advantage Prior Authorization analysis. Methodology and editorial review by PlainInsurer, see methodology.