For illnesses or injuries that are not life threatening, please utilize our provider search tool to find an Aetna Provider for an Urgent Care, Walk in Clinic or Physician’s office near you. This Policy utilizes the Aetna Provider hospital and Doctor network for the purpose of delivering quality health care at a preferred fee. You are not required to use the PPO network but you may incur expenses that are not covered under your policy by utilizing an out of network provider. Please contact CISI for additional information. You are also welcome to use Retail Clinics at CVS, Walgreens, Walmart, Target or Kroger stores.

If you visit a medical provider (doctor, hospital, clinic, etc) that is not in the Aetna network, you may be required to pay for these services yourself. If so, please specifically request an itemized bill from the medical provider to submit to your insurance. The itemized bill includes diagnosis and procedure codes necessary to process a claim. This type of bill is standard in medical billing in the United States. Once you have this, a claim form (PDF) can be completed and submitted to CISI.

If you are being treated for an illness or injury which would otherwise be covered under your CISI policy, your physician prescribed medication would also be covered. All prescription medications must be paid by you to the pharmacy at the point of purchase. You are encouraged to download the Prescription Rx Card.
A claim for reimbursement can be made by submitting the prescription receipt and a completed claim form (PDF). The prescription receipt is normally stapled to the outside of the pharmacy bag and includes your name, your physician’s name, the name of the medication, the dosage and the amount charged. Cash register receipts will not be considered for reimbursement. Once you have this, a claim form can be completed and submitted to CISI.

A claim form (PDF) should be completed. Please be sure to include a brief description of the accident or illness that treatment was received for. The claim form will need to be submitted with any itemized bills that you have.
Instructions:
Complete and sign the medical claim form, indicating whether the Doctor/Hospital has been paid.
Attach itemized bills for all amounts being claimed. *We recommend that you either make photocopies of the originals for yourself, or keep the originals and submit the photocopies to CISI in case anything gets lost in the mail.
When reimbursement of an expense is approved, it will be made to the provider of the service unless the bill is noted as having been paid by you.
Payment will be mailed in U.S. dollars unless otherwise requested.
If the payment is to you, it will be mailed to your U.S. address unless otherwise requested.

A claim form (PDF) reimbursement can be made by submitting the prescription receipt and a completed claim form . The prescription receipt is normally stapled to the outside of the pharmacy bag and includes your name, your physician’s name, the name of the medication, the dosage and the amount charged. Cash register receipts will not be considered for reimbursement. If you no longer have the prescription receipt most pharmacies can reprint it for you. Reimbursement claims cannot be processed with register receipts.
For claim submission questions, call (203) 399-5130, or e-mail claimhelp@mycisi.com.

Claim forms (PDF) are requested when additional information on an illness or injury is needed. Please complete the form detailing as much information as you can about your condition. Some information we could be looking for : If an illness: When did you first notice symptoms? What were the symptoms? Where you treated for this condition previously? If so, when? If an injury: Where were you when the injury happened? What were you doing? How did the injury occur?

You may have submitted a claim that did not include the diagnosis and procedure coding needed to process your claim. First, check your original submission. Did you submit a receipt or a statement from the medical provider? This is generally what is provided to patients but additional information is needed for insurance processing.

If you are looking for CISI to pay your claim to the medical provider
Contact the medical provider that has billed you and ensure that they have your insurance information. At the time you received our letter, we would have sent the same letter to the medical provider requesting the same bill. However, if you did not provide that medical provider with your insurance information, they may be unwilling or unable to send CISI the itemized bill due to privacy laws. You will need to submit your insurance information to the medical provider (there are usually spaces on the back of your statement from the facility with spaces to complete this information) and send it back to the provider. They also may be able to take this information from you over the phone. This way, they can send CISI what is needed directly.

If you are looking for reimbursement from CISI for medical services you have paid
You likely only submitted a receipt of payment to CISI. You can contact the medical provider whom you paid and ask for an itemized bill to submit to your insurance company. This type of billing is standard in the United States. The provider can send this bill to you and then you can resubmit a claim to CISI or the provider is welcome to send this directly to CISI.