By Counterforce Health Team in iLink® (corneal cross-linking system) —

Get iLink® Corneal Cross-Linking Covered by Cigna in Pennsylvania: Complete Forms, Appeals & Contact Guide

Quick Start: Getting iLink® Covered by Cigna in Pennsylvania

Prior authorization is required for iLink® corneal cross-linking with Cigna in Pennsylvania. The fastest path to approval: 1) Have your ophthalmologist document progressive keratoconus with serial topography and pachymetry, 2) Submit the Cigna medical prior authorization form via fax (866-873-8279) or provider portal with complete clinical records, and 3) If denied, use Pennsylvania's new external review program—about 50% of appeals are overturned. Start today by calling your eye doctor to schedule progression documentation and confirm they'll handle the prior authorization submission.

Table of Contents

Verify Your Plan Coverage

Before starting the approval process, confirm your specific Cigna plan details:

What to Check:

  • Log into your myCigna account to verify your current benefits
  • Confirm whether your pharmacy benefits are managed through Express Scripts
  • Check if you have a commercial plan, Medicare Advantage, or Medicaid managed care
  • Verify your ophthalmologist is in-network for the procedure
Note: Cigna covers only the FDA-approved epithelium-off iLink® procedure using Photrexa® solutions and the KXL® system. The epithelium-on method is considered experimental and not covered.

Required Forms & Documentation

Primary Form

Cigna Medical Prior Authorization Form - Required for all iLink® procedures

  • Submit via: Fax to 866-873-8279 or online provider portal
  • Alternative: Electronic prior authorization through CoverMyMeds

Essential Clinical Documentation

Your ophthalmologist must include:

  • Progressive keratoconus diagnosis with ICD-10 code
  • Serial corneal topography showing worsening over time
  • Pachymetry measurements documenting corneal thinning
  • Visual acuity changes demonstrating functional decline
  • Prior treatment failures (contact lenses, glasses)
  • Medical necessity statement explaining why iLink® is required
Tip: Incomplete documentation is the #1 reason for delays. Ensure all progression evidence spans at least 3-6 months of monitoring.

Submission Methods

Online Portal (Fastest)

  • Cigna Provider Portal: Log in through cigna.com
  • CoverMyMeds: Electronic submission with real-time status updates
  • Processing time: 5 business days for standard requests

Fax Submission

  • Number: 866-873-8279
  • Cover sheet required: Include patient Cigna ID and urgency level
  • Confirmation: Call 1-800-882-4462 to verify receipt

Phone Support

  • Provider line: 1-800-882-4462
  • Urgent requests: Mark as expedited and call to notify
  • Member services: Available through myCigna account

Step-by-Step: Fastest Path to Approval

1. Schedule Progression Documentation (Patient)

Timeline: 1-2 weeks
Contact your ophthalmologist to schedule comprehensive testing including corneal topography and pachymetry. Request copies of all previous eye exams to document progression.

2. Clinical Assessment (Ophthalmologist)

Timeline: 1 visit
Your doctor will perform complete evaluation and compile evidence of progressive keratoconus, ensuring all Cigna medical necessity criteria are met.

3. Prior Authorization Submission (Ophthalmologist)

Timeline: Same day
Submit completed form via fax (866-873-8279) or online portal with all supporting documentation.

4. Cigna Review Process

Timeline: 5 business days
Cigna reviews submission for medical necessity. Standard processing time applies unless marked urgent.

5. Approval or Denial Notification

Timeline: Within 24 hours of decision
You and your doctor receive determination letter. If approved, schedule procedure. If denied, proceed to appeals.

6. Procedure Scheduling (If Approved)

Timeline: 2-4 weeks
Schedule iLink® treatment at approved facility. Confirm all requirements are met before procedure date.

7. Appeal Process (If Denied)

Timeline: 180 days to file internal appeal
Follow Pennsylvania-specific appeals process detailed below.

Common Denial Reasons & How to Fix Them

Denial Reason Solution Required Documentation
Insufficient progression evidence Submit serial corneal maps spanning 6+ months Topography reports with dates
Missing medical necessity Provide detailed clinical rationale letter Ophthalmologist statement
Non-FDA approved method Confirm epithelium-off technique only Procedure specification
Prior therapy not documented Show contact lens/glasses failure Treatment history records
Incomplete prior authorization Resubmit with all required fields Complete PA form

Appeals Process in Pennsylvania

Pennsylvania offers one of the strongest external review programs in the nation, with about 50% of appeals overturned in 2024.

Internal Appeals (Required First Step)

Timeline: Must file within 180 days of denial
Process: Submit Cigna appeal form with additional clinical evidence
Decision: 15 days for standard, 72 hours for urgent

Pennsylvania External Review (After Internal Appeals)

Eligibility: Must have Final Adverse Benefit Determination letter from Cigna
Timeline: 4 months to file after final internal denial
Submit via: Pennsylvania Insurance Department portal or call 1-877-881-6388
Decision: 45 days for standard review, 72 hours for expedited

Required Documents for External Review:

  • Final denial letter from Cigna
  • All internal appeal correspondence
  • Complete medical records
  • Physician statements supporting medical necessity
  • Any additional clinical evidence
From our advocates: One Pennsylvania patient successfully overturned their iLink® denial by submitting updated corneal topography showing rapid progression over just 4 months, along with a detailed letter from their corneal specialist explaining why traditional treatments had failed. The external reviewer agreed the evidence clearly demonstrated medical necessity.

Specialty Pharmacy Requirements

For medications related to the iLink® procedure, Cigna typically requires use of Accredo specialty pharmacy.

Enrollment Process

  1. Provider referral: Your ophthalmologist submits prescription to Accredo
  2. Insurance verification: Accredo confirms coverage with Cigna/Express Scripts
  3. Account setup: Register at accredo.com or call 877-826-7657
  4. Delivery coordination: Medications shipped to your home at no extra cost

Contact Information

  • Accredo patient line: 877-826-7657 (Mon-Fri 7am-10pm, Sat 7am-4pm CST)
  • Express Scripts portal: Available through your member account
  • Provider referral forms: Available at accredo.com

Support Contacts

For Patients

  • Cigna Member Services: Available through myCigna account or member ID card
  • Prior Authorization Status: 1-800-882-4462
  • Appeals Support: Cigna appeals hotline

For Providers

  • Prior Authorization Fax: 866-873-8279
  • Provider Services: 1-800-882-4462
  • Urgent Requests: Same number, specify urgency

Specialty Support

  • Accredo: 877-826-7657
  • CoverMyMeds: Online portal for electronic PA submission
  • Express Scripts: Through member portal if pharmacy benefits managed separately

When to Contact State Regulators

Contact the Pennsylvania Insurance Department if:

  • Cigna violates appeal timelines
  • You're denied access to external review
  • There are billing disputes after approval
  • You need help navigating the appeals process

Pennsylvania Insurance Department
External Review Line: 1-877-881-6388
Consumer Services: Available through pa.gov
Online Portal: Submit external review requests electronically

Additional Resources:

  • Pennsylvania Health Law Project: Free assistance with complex appeals
  • Pennie (PA Marketplace): Consumer hotline for marketplace plans
  • Consumer Assistance Program: Help for low-income individuals

At Counterforce Health, we help patients, clinicians, and specialty pharmacies turn insurance denials into successful appeals. Our platform analyzes denial letters and plan policies to create targeted, evidence-backed appeals that align with each payer's specific requirements. We pull the right clinical citations and weave them into appeals with all the required documentation, helping you navigate complex prior authorization and appeals processes more effectively.

FAQ

How long does Cigna prior authorization take for iLink® in Pennsylvania?
Standard processing is 5 business days. Urgent requests marked for expedited review may be processed faster.

What if iLink® is not on Cigna's formulary?
iLink® is a medical procedure device, not a formulary drug. Coverage is determined by medical necessity criteria, not formulary status.

Can I request an expedited appeal in Pennsylvania?
Yes, both Cigna internal appeals and Pennsylvania external reviews offer expedited pathways for urgent medical situations. Processing time is 72 hours for urgent cases.

Does step therapy apply to iLink® corneal cross-linking?
Cigna typically requires documentation of contact lens or glasses failure before approving surgical interventions. This isn't formal step therapy but medical necessity evidence.

How much does iLink® cost without insurance?
The procedure typically costs $2,500-$4,000 per eye, but costs vary by facility and geographic location.

What happens if Pennsylvania external review overturns my denial?
If the independent reviewer rules in your favor, Cigna must provide coverage immediately, including retroactive coverage if you paid out-of-pocket.

Can I use any ophthalmologist for iLink® with Cigna?
Your ophthalmologist must be in-network and the facility must be approved for the iLink® procedure. Verify both before scheduling.

How often can I get iLink® treatment covered?
Cigna typically covers one treatment per eye per lifetime unless special criteria for repeat treatment are met.

Sources & Further Reading

When you're working with Counterforce Health to appeal a denial, we help ensure your submission includes all the clinical evidence and procedural requirements that Pennsylvania external reviewers and Cigna look for in successful appeals.

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider and insurance plan directly for personalized guidance. Coverage policies and procedures may change; verify current requirements with official sources.

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