Quick answer
Cigna's behavioral health benefits are managed by Evernorth Behavioral Health, which reviews and authorizes care around the clock and uses ASAM criteria for substance use disorder medical necessity reviews. Higher levels of care like residential or inpatient treatment generally require precertification, and federal parity rules apply to how those benefits are managed.
Somewhere between the fear of asking for help and the fear of the bill sits one question: will Cigna cover this? The short version is that Cigna plans include behavioral health benefits covering mental health and substance use disorder care, those benefits are administered by a Cigna subsidiary called Evernorth Behavioral Health, and there is a defined process - precertification, medical necessity review, appeal rights - that you can actually follow rather than guess at. Your specific plan documents settle what is covered and what you pay.
Who Evernorth is and what they manage
Evernorth Behavioral Health, Inc. is a subsidiary of Cigna and the behavioral health network for customers with Cigna health plans. Its administrative guidelines state that it manages mental health and substance use disorder services for benefit plans in compliance with applicable laws, including the federal Mental Health Parity and Addiction Equity Act, the Affordable Care Act, and state parity laws. In practice that means when you call the mental health and substance use number printed on your Cigna ID card, you are reaching Evernorth's side of the house.
Evernorth's provider manual describes clinical staff available 24 hours a day, 7 days a week to review and authorize coverage, and states that when medical necessity is met for a requested level of care, coverage can be arranged at a participating facility.
What typically requires precertification
Evernorth's provider manual is direct about this: coverage for any higher level of care must be preauthorized. Cigna's published precertification lists detail the specific services, which for behavioral health generally include:
- Inpatient mental health and inpatient substance use detoxification
- Hospital-based substance use rehabilitation
- Residential treatment
- Intensive outpatient programs and partial hospitalization
- Other structured behavioral health services
Standard outpatient therapy visits generally do not require it, though your plan documents are the final word. If a treatment center says "we take Cigna," the follow-up question is whether they have started the precertification for your specific level of care - and what Evernorth said in response.
Medical necessity: the ASAM Criteria
How does Evernorth decide whether residential rehab or IOP is medically necessary for you? Its coverage policies name the standards: the ASAM Criteria - the American Society of Addiction Medicine's national guidelines for placement, continued stay, and transfer or discharge of patients with addiction - for substance use disorder levels of care, and MCG Behavioral Health Guidelines for mental health levels of care. In states with specific requirements such as California's SB 855, LOCUS criteria are used for mental health levels of care as state law directs.
ASAM-based review means the decision turns on clinical dimensions familiar to anyone who has been assessed for treatment: withdrawal risk, medical and psychiatric conditions, readiness to change, relapse risk, and the recovery environment you are going home to. It also means the criteria are an external, published standard - you can ask what was applied to your case rather than being told only "not covered."
Support beyond the benefit
Evernorth's provider manual describes Coaching and Support (C&S) programs that help people initiate and engage in behavioral treatment, including a substance use program. Cigna case managers trained in working with mental health and substance use disorders use a motivational interviewing approach focused on lowering the barriers - internal and external - that keep people from starting or staying in treatment. The programs also cover opioid and pain management, and an intensive behavioral case management option for people who need more sustained help.
That matters if your hesitancy is not really about coverage but about whether you can actually get through the door. Someone whose job is helping you take that step exists on the payer side, and you reach them through the behavioral health number on your ID card.
Parity and your rights
Federal parity law does not force Cigna to cover substance use disorder benefits, but because Cigna plans do cover them, parity applies: financial requirements like copays, and treatment limitations like prior authorization, must be no more restrictive for substance use and mental health care than the predominant requirements applied to medical and surgical benefits. Comparisons are made within six benefit classifications, including inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, emergency, and prescription drugs.
If a request is denied, you can appeal and you can ask for the criteria behind the decision. SAMHSA's "Know Your Rights" guide walks through filing claims, appealing denials, and what your plan must disclose. Keep copies of everything - dates, reference numbers, letters.
If you would rather not navigate it alone, call (800) 653-9376. The call is free to you, the referral service is paid for by treatment providers, and no one is going to lecture you about how long you waited to make it. SAMHSA's National Helpline (1-800-662-4357) is another free, confidential option available around the clock.
Questions about Cigna Coverage
Who actually manages Cigna's behavioral health benefits?
Evernorth Behavioral Health, Inc., a Cigna subsidiary, is the behavioral network for customers with Cigna health plans. Its provider materials state that it manages mental health and substance use disorder services in compliance with federal and state parity laws, including the Mental Health Parity and Addiction Equity Act.
Does Cigna require precertification for rehab?
For higher levels of care, yes. Evernorth's provider manual notes that coverage for any higher level of care must be preauthorized, and precertification lists published for Cigna plans detail the inpatient, residential, and outpatient services that require it. Outpatient office visits generally do not.
What criteria does Evernorth use to approve substance use treatment?
According to Evernorth's coverage policies, it uses the ASAM Criteria - the American Society of Addiction Medicine's standards - for medical necessity reviews of substance use disorder levels of care, and MCG Behavioral Health Guidelines for mental health levels of care, unless contract or law requires different criteria.
Does Cigna offer help starting treatment besides coverage?
Yes. Evernorth's provider manual describes Coaching and Support (C&S) programs, including one specifically for substance use, where case managers trained in working with mental health and substance use disorders use motivational interviewing to help people start and stay engaged in treatment.
What if Cigna denies the treatment I need?
You can appeal, and you can request the medical necessity criteria that were applied to the decision. SAMHSA's parity materials explain your rights to claim, appeal, and disclosure. If you are in crisis, call or text 988; for a medical emergency, call 911.