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When the Cigna appeals process has been exhausted, what happens if the provider still disagrees with the decision?

a.The provider must send a letter of explanation to the appeal board.
b.The claim is sent to a second level of appeal.
c.The claim goes into arbitration.
d.There is no way to dispute a single-level appeal.

User SvdSinner
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Final answer:

If a provider still disagrees with Cigna's appeal decision after the process has been exhausted, the subsequent steps may involve arbitration or legal action, depending on the contract's terms. Providers should seek legal advice due to the matter's complexity.

Step-by-step explanation:

When the Cigna appeals process has been exhausted and the provider still disagrees with the decision, the next step may involve arbitration or taking legal action if the appeal process allowed and the parties cannot resolve the dispute. In many cases, insurance contracts have clauses that specify the steps to be taken if disputes arise post-appeal. It's essential for providers to review the terms of their contract with Cigna to understand the options available to them. Moreover, providers are typically advised to seek legal assistance in appealing decisions, given the complexity of insurance law.

It's worth noting that in the realm of zoning appeals, statutes often create boards of zoning appeals, which are quasi-judicial bodies with the power to conduct hearings and make decisions subject to court review. This parallels the process in which a provider may contest a decision made by an insurance company like Cigna.

User RBR
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