Why Out-of-Network Benefits Show "No Benefits Returned" When Payer Confirms Shared Amounts (CRM)
Overview
You may see "No benefits returned" in the Out-of-Network section of a VOB even when the payer — such as Cigna — has confirmed that the same deductible and out-of-pocket amounts apply to both In-Network and Out-of-Network coverage. This article explains how Dazos handles shared benefit amounts, what to expect in each scenario, and why some plans return less detail electronically.
When to Use / Why It Matters
This applies when you run an electronic VOB and notice that the Out-of-Network section displays "No benefits returned" or is missing values, even though the In-Network section is populated and the payer has confirmed shared benefit amounts. It is especially relevant for Cigna plans and certain union plans.
How Dazos Displays Shared In-Network / Out-of-Network Benefits
When a payer confirms that the same deductible and out-of-pocket amounts apply to both In-Network and Out-of-Network, Dazos will display those values in both sections of the VOB.
To help you understand why a value appears in the Out-of-Network section, an information icon is shown next to each shared value. Clicking or hovering over this icon displays the payer's note confirming that the amounts are shared between In-Network and Out-of-Network.
What Determines What Appears in the Out-of-Network Section
The Out-of-Network section displays only what the payer returns electronically. There are three possible outcomes:
Payer confirms shared amounts: Dazos populates the Out-of-Network fields with the same values returned for In-Network, and displays an information icon confirming the amounts are shared.
Payer returns separate Out-of-Network benefits: Dazos displays those specific OON values as returned by the payer.
Payer does not provide a specific field (e.g., Individual Deductible): That field will show "OON benefits not returned" even if other OON fields are populated. This is expected — Dazos only displays what the payer confirms.
⚠️ Important: "No benefits returned" or missing OON values do not indicate a system error. They reflect exactly what the payer returned in the electronic response.
Why Some Cigna and Union Plans Return Limited Data Electronically
Some insurance plans — including certain Cigna plans and union plans — only release a full benefit breakdown (deductibles, out-of-pocket amounts, coinsurance) directly, either through their own portal or via a phone call to their benefits line. These plans do not release the same level of detail through electronic verification.
This is a policy decision controlled by the insurance carrier, not a limitation of Dazos. As a result, the electronic VOB may return less information than what is visible on the insurer's own member portal.
💡 Tip: If the electronic VOB returns limited benefit detail for a Cigna or union plan, log in to the Cigna portal or call Cigna's benefits line directly to obtain the full breakdown. You can also complete a Live VOB for manual confirmation.
Tips & Notes
✅ Best Practice: Always review the information icon next to Out-of-Network values to understand whether the amount is payer-confirmed as shared or returned as a separate OON benefit.
⚠️ Note: If a specific OON field shows "OON benefits not returned" while other OON fields are populated, this means the payer did not return data for that specific field — it is not a bug.
💡 Tip: For plans where the electronic VOB consistently returns limited data, consider using a Live VOB or contacting the payer directly as your standard workflow for those members.