How do insurance denial appeals work?

Upload your denial letter and Lysco analyzes it, identifies the denial reason, cites applicable laws (ACA, ERISA, state regulations), and generates a customized appeal letter. You review and submit it yourself.

What is the success rate for insurance appeals?

It varies by plan type. For ACA marketplace plans, about 44% of appealed denials are overturned (KFF, 2023). For Medicare Advantage, it can be as high as 83% (HHS OIG). Many denials stem from billing or administrative errors that get fixed when challenged. Individual results vary.

Is Lysco a law firm or medical practice?

No. Lysco is an informational tool that helps you understand your rights and options. It is not a law firm, medical practice, or insurance company. For specific legal or medical situations, consult a licensed professional.

How much does Lysco cost?

Analysis is always free and your first appeal letter is free too. Upgrade to Pro ($29/mo) or Annual ($199/year) for unlimited appeal letters, insurer playbooks, and benefits finder. Cancel anytime.

Is my health data secure on Lysco?

Yes. Lysco uses AES-256 encryption at rest, TLS for data in transit, and row-level security so only you can access your data. We never sell your data and follow HIPAA-aligned security practices.

Cigna Healthcare

Also known as: Cigna, Cigna Healthcare, The Cigna Group, Evernorth

EmployerIndividualMedicare Advantage

Common Denial Patterns

Medical necessity denials using proprietary coverage policies
Prior authorization denials for advanced diagnostics
Out-of-network denials in limited network plans
Step therapy and formulary restrictions

Appeal Best Practices

1Reference the specific Cigna Coverage Policy
2Request peer-to-peer review early
3Document any network inadequacy issues
4Include all clinical records in first appeal (dont save evidence for later)

Known Weaknesses

Coverage policies sometimes lag behind guidelines
Network adequacy issues in rural areas
Evernorth pharmacy benefits create potential conflicts for drug denials

Contact & Response

Best Contact Method

Member portal > Fax > Mail

Typical Response Time

30 days (internal), 45 days (external)

Internal Criteria Used

Cigna Coverage Policies
MCG

General Tips

Cigna publishes Coverage Policies online — reference the specific policy
Cigna offers peer-to-peer review through the provider
Member portal allows online appeal submission
Cigna uses both MCG and proprietary criteria

Have a denial from Cigna Healthcare?

Upload your denial letter for free analysis. Lysco uses Cigna Healthcare-specific intelligence to identify weak points and draft your appeal.

Upload Your Denial — Free

This information is for educational purposes based on publicly available data including CMS reports, state insurance department filings, and published insurer guidelines. It does not constitute legal, medical, or financial advice. Individual results vary. Verify all information independently and consult qualified professionals before acting.