I have Cigna and personally they have been an absolute pain in my ass. I had my Top Surgery on June 16th 2015, I had contacted Cigna in April and asked what I was supposed to do to get covered by someone out of network. The girl on the phone told me to basically pay for it out of pocket and then file a claim. So i shelled out $8450 (I think) and filled out my claim. I had my doctor fill out about 6 forms for me and she ended up having to fill it out 3 times because Cigna kept sending it back to me and saying they didn't have enough information. At my 6 week post op I had her fill out the forms again and they had sent them in to Cigna for me on July 29th 2015.
Cigna denied my Short Term Disability from work and said again "not enough information" and they sent me back the same form that my doctor filled out entirely. I had to go 6 weeks without any pay and still haven't gotten that back. I then received another letter from Cigna saying that they did not receive ANY of my paper work from my doctor. I called my doctor and she assured me that everything they wanted was filled out and sent to them. So the way I see it is Cigna doesn't want to pay me, even though I pay about $130 every two weeks out of my check for insurance that "supposedly" covers 100% of transgender surgery.
On a lighter note my best friend also has Cigna (he works at the same company as me) and he is going to go to Dr.Kathy Rumer in PA. She takes Cigna and requires a letter from your gender therapist. He called Cigna and all they needed were codes and all that other crap. So hopefully his surgery doesn't cost him a dime. I learned my lesson though and I plan on going back to the cheapest Cigna plan they have when I'm done :p