Emily Carter
Insurance
Cigna
Open Access Plus
Member ID
CIG-55667788
Group Number
GRP-3344
Copay
—
Deductible
—
Effective Date
Active Authorization
Active3.5 — Clinically Managed High-Intensity Residential
Residential Treatment · Residential treatment
Auth Number
AUTH-2026-00347
Date Range
2026-03-11 — 2026-03-25
UR Due Date
2026-03-23Overdue
Authorization History
| Date | ASAM Level | Days | Outcome |
|---|---|---|---|
| 2026-03-11 | 3.5 Clinically Managed High-Intensity Residential | 14 | Approved |
| 2026-02-25 | 3.5 Clinically Managed High-Intensity Residential | 14 | Approved |
| 2026-02-01 | 3.5 Clinically Managed High-Intensity Residential | 30 | Approved |
ASAM Level Reference
Outpatient Services
< 9 hours/week
Clinically Managed Low-Intensity Residential
Halfway house / sober living
Intensive Outpatient (IOP)
9-19 hours/week
Partial Hospitalization (PHP)
20+ hours/week
Clinically Managed Low-Intensity Residential
Structured sober living
Clinically Managed High-Intensity Residential
Residential treatment
Medically Monitored Intensive Inpatient
24-hour medical monitoring
Medically Managed Intensive Inpatient
Hospital level
Claims
| Date | CPT | Description | Billed | Status |
|---|---|---|---|---|
| 2026-03-22 | 90837 | Individual Therapy (53 min) | $185.00 | Paid |
| 2026-03-21 | H0004 | Group Counseling | $65.00 | Submitted |
| 2026-03-20 | 90792 | Psychiatric Evaluation | $310.00 | Submitted |
| 2026-03-18 | H0015 | Residential Per Diem | $450.00 | Paid |
| 2026-03-15 | 90837 | Individual Therapy (53 min)Auth expired | $185.00 | Denied |