Cigna · Ect · US health-plan appeal rights

Ect denied as not FDA-approved for this use by Cigna?

Q: How long do I have to appeal a Cigna Ect denial?

Internal appeal window: Typically 180 days from the denial date. External review window: Typically 60–120 days after the final internal denial. The clock starts from the date on the denial letter.

Off-label use is widespread in medicine. If the literature and a recognised specialty-society guideline support the use, plans frequently approve on appeal — especially for cancer, cardiology, and rare disease.

By Michael John Ryan, Founder & Privacy Officer, DenialHelp, LLC

Last reviewed 2026-05-09

Policy data current as of 2026-04-26

US health-plan appeal rights

Cite: Most US health plans have appeal rights under either the ACA, ERISA, or Medicare/Medicaid rules

Most US health plans are required by federal law to give you both an internal appeal (where the insurer reconsiders) and an external review (where an independent reviewer decides). The exact timelines and processes depend on what kind of plan you have — marketplace / employer group, self-funded, Medicare Advantage, or Medicaid MCO — but in every case there's a window after the denial during which you have the right to fight it.

Internal appeal window

Typically 180 days from the denial date

External review window

Typically 60–120 days after the final internal denial

What Cigna typically requires

Severe MDD (with or without psychotic features), bipolar depression, catatonia, mania, or selected schizophrenia. Index acute course typically 6-12 sessions (RUL ultra-brief or bilateral). Continuation/maintenance ECT covered per CORE protocol after acute response. Anesthesia evaluation, EKG, labs required. Pregnancy / geriatric / medical-comorbid populations covered with informed consent.

Source policy: Cigna Medical Coverage Policy: Electroconvulsive Therapy

What works in the appeal

ECT FDA Class II reclassification Dec 2018 final rule — for MDD, bipolar depression, catatonia. APA Practice Guideline + AAN 2018 + ISEN — first-line for severe MDD with psychosis, catatonia, suicidality, geriatric MDD, pregnancy MDD. INTREPID Lisanby AJP 2017 — efficacy + safety. CORE Kellner Br J Psychiatry 2010 — continuation ECT vs pharmacotherapy. GUIDE Kellner J ECT 2016 — ultra-brief pulse RUL with comparable efficacy + reduced cognitive effects. Bilateral indicated for psychosis / catatonia / treatment-urgent presentations.

Next steps

Find the date on the denial letter — your appeal window starts there.
Read your plan's Summary of Benefits and Coverage (SBC) for the specific deadlines.
Request the insurer's claim file in writing — they must provide it.
Submit your appeal in writing with new clinical evidence and a physician statement.

Get the letter drafted

DenialHelp drafts your appeal in 5 minutes — $40 list price, $30 for your first letter (use code SEO25). We cite the federal regs and the specific clinical evidence your plan responds to. Your physician signs and sends.

Start my appeal — $30 with code SEO25 →

Related appeal guides

Other Cigna appeals

Other denial reasons for Cigna Ect

denied as not medically necessary denied for failing step therapy denied as non-formulary denied for missing prior authorization denied as experimental or investigational

This guide describes general US federal appeal rights based on Most US health plans have appeal rights under either the ACA, ERISA, or Medicare/Medicaid rules. Your specific plan documents (Summary of Benefits and Coverage, Evidence of Coverage) override anything here. DenialHelp is not your lawyer and not your physician — we draft appeal letters that your physician signs. Outcomes depend on your insurer's decision and factors outside our control. Reviewed by Michael John Ryan on 2026-05-09. Editorial standards: denialhelp.com/authors.