Frequently Asked Questions

Before joining the Cigna network of contracted doctors, health care professionals must meet CIgna standards through a process called credentialing. We regularly review doctors' credentials to ensure they continue to meet these standards.

Any doctor not already under contract with Cigna who is able to meet the terms and conditions for participation may apply to join the network.

Even when a doctor is listed in the directory, it doesn't guarantee that the services provided by that doctor are covered under your specific medical plan. Check your plan documents, which describe your particular plan coverage, or call Cigna Customer Service using the number listed on the back of your ID card for information about the services covered under your plan.

If you'd like a paper copy of the directory or help locating a doctor please call Cigna Customer Service at the number listed on the back of your ID card. Help is available to locate a doctor or get a list of doctors. These doctors are qualified to deliver the type of care or covered services you need and are currently taking new patients. If you need help making appointments, call Customer Service.

The best way to find in-network doctors while searching the directory is to log in to your myCigna account, so the search is done with your plan settings.

On myCigna you can also view information on preventive care and other health topics, and learn more about your plan's coverage and your health and wellness programs.

You can see details of your coverage and the types of services covered simply by logging in to your myCigna account. Your coverage details show whether you have prescription drug coverage, coverage for mental health and substance abuse, and/or vision care coverage as a part of your health plan.

Read your Summary of Benefits and other plan documents. If there are any differences between these and what you see on myCigna, your Summary of Benefits is correct.

If you are eligible for the Network Savings Program (NSP), you will see either the Multiplan or Viant network logo printed on your ID card.

NSP is an out-of-network discount program for doctors not in Cigna's network. Your best option for helping to keep your costs low is always to try and use in-network doctors. NSP doctors listed in the directory may offer discounts if you use their services, but these are not guaranteed even if you are eligible for this program. Cigna does not review or credential NSP (out-of-network) doctors for cost and quality and you could pay significantly more for doctors who are out-of-network (NSP) than if you used in-network doctors.

PCP stands for Primary Care Physician. Your PCP will be your source for basic care, advice and direction. Your PCP will also coordinate your total care - from preventive checkups and routine medical care to specialized care and hospitalizations.

Your PCP could be any of the following: family doctor, general practice doctor, internist or internal medicine doctor, OB/GYN or pediatrician; also nurse practitioner (depending on your state's regulations), naturopathic doctor (Vermont) or physician assistant (Massachusetts).

Not necessarily. It depends on the type of plan you have. Some plans require you to choose a PCP; some don't:

• If you have a Network, Network POS, or HMO plan, you are required to choose a PCP.
• If you have the Open Access Plus (OAP) plan, you are encouraged to choose a PCP, but it is not required.

No. Each member of your family can choose his or her own PCP or personal doctor.

Depending on your plan you may or may not be required to choose a Primary Care Physician (PCP). Even if you don't have to choose a PCP, there are advantages to having a personal doctor who coordinates your care. Your PCP will:

• Be your source for basic care, advice and direction.
• Coordinate your total care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• Get to know you. Developing a relationship with your PCP will help you better manage your overall health.
• Provide you with referrals to specialists when necessary, if required as a part of your plan.

It depends on your plan coverage. You should refer to your plan documents to learn whether your plan requires you to have a referral before seeing a specialist.

• If required as a part of your plan, your PCP will also give you referrals to specialists when necessary.
• If your plan requires referrals and your PCP is part of a medical group, you may be required to see a specialist who practices in that group for services to be covered. Check with your PCP or call Cigna Customer Service at the number listed on the back of your ID card to learn whether this requirement applies to you.

You do not need a referral to see your OB/GYN for an annual preventive care exam, often called a Well Woman exam. Also, if your OB/GYN identifies a medical condition during a Well Woman exam, your OB/GYN can continue to treat you for that condition.

Yes, you can change your PCP at any time by calling the toll-free Customer Service number on your ID card or by logging into myCigna.

If we receive your PCP change request by the 25th of the month, your PCP change will begin on the first day of the following month.

NOTE: If you are receiving specialty care and decide to change your PCP, your new PCP will need to provide a referral to your specialist for any services received after the start date of your PCP change.

When you need medical care, it's important that your doctor, hospital or other health professional sees you as soon as possible. There are standards, required by law, to make sure your appointment happens in a timely manner.

The following legal standards set the number of days or weeks you can wait for an appointment based on your medical needs:

Emergency: Immediately.
Emergencies are medical problems that are life-threatening. Examples are heart attacks or serious injuries.

Urgent: Within 24 - 48 hours.
Urgent medical needs are not emergencies, but they do require prompt medical attention. They include illnesses with symptoms, such as the flu, infections and broken bones that can be set in a medical office instead of in a hospital.

Regular or Routine Care: 7 - 14 days.
These are medical needs that can wait. Examples are routine blood work or a blood pressure check after your doctor prescribes a new medication.

Preventive Screenings and Physicals: Within 30 days.
These include your annual physical and preventive screenings. Examples are mammograms and cervical or prostate cancer screens.

Obstetric Prenatal Care: The standard depends on the stage of your pregnancy and your medical situation:

• Immediately - if you are considered high risk or there is an urgent need to see a doctor
• Within 14 days - if you are within the 1st trimester of pregnancy, you are not high risk and the medical problem is not urgent
• Within 7 days - if you are in the 2nd trimester
• Within 3 days - if you are in the 3rd trimester

To ensure all customers receive timely care, Cigna conducts an annual survey of doctors, hospitals and other health care professionals to make sure they are complying with these standards.

Doctors, hospitals and other health care professionals are required by law to conform to standards for scheduling medical appointments. These standards are based on your medical needs.

If you feel that your doctor, hospital or other health professional is not scheduling appointments in a timely way or is not complying with the legal standards, you can notify Cigna by:

• Contacting a Nurse using our 24-Hour Health Information Line, available 24 hours a day, 365 days a year: 1.800.244.6224
• Calling Cigna Customer Service at the toll-free number listed on the back of your ID Card

Precertification is a review process where Cigna nurses, pharmacists and/or doctors work with your doctor to decide:

• Whether a routine hospital stay or outpatient procedure is approved/covered under your plan
• What your coverage will be for a procedure or service if you use a doctor who is not in the Cigna network.

• If your doctor is part of the Cigna network, then he or she is responsible for contacting Cigna to begin the precertification process.
• If you use a doctor who is not part of the Cigna network, then you are responsible for contacting Cigna to begin the precertification process. It is important for you to understand which services require precertification. You can do this by reviewing your plan coverage or contacting Cigna at the number on your Cigna ID card.

Your plan may require precertification for hospital admissions and some outpatient services. When precertification is required, a Cigna nurse reviews the request using nationally recognized guidelines. These guidelines help the nurse decide what services are covered based on your plan coverage. The guidelines have been developed with involvement from actively practicing health care professionals and are consistent with sound clinical principles and processes. If there are no guidelines available for a service, the nurse uses clinical resource tools based on clinical evidence instead.

If a Cigna nurse is unable to approve coverage for clinical reasons, the case is referred to a Cigna doctor, who considers each case on an individual basis. The Cigna doctor may speak with your doctor to get more information. The Cigna doctor makes the decision based on the information received and your plan coverage. You and your doctor will be notified in writing if a request for a precertification cannot be approved.

The review process can happen at three different times:

• Cigna receives a request before you receive care (prospective review). Decisions are made within two business days of receiving all necessary information. You and your doctor will be notified by phone, email and by U.S. Mail.
• Cigna receives a request while you are receiving care or in a hospital, skilled nursing facility or rehabilitation facility (concurrent review). Decisions are made within one business day of receiving all necessary information. You and your doctor will be notified by phone, email and by U.S. Mail.
• Cigna receives a request after you have received care (retrospective review). Decisions related to these services are made within thirty days after receiving all necessary information. You and your doctor will be notified by phone, email and by U.S. Mail.

If your situation requires that a decision is made right away (expedited review), then Cigna will perform a quick review. This decision will be completed within one business day.

Medical doctors evaluate coverage denials when clinical factors are the reason for the denial. A denial letter will explain the reason for the decision. The letter will also provide details on how to submit additional information and/or how to proceed through the formal Appeals Process, if you disagree with the coverage decision.

You can search for places by type ("cancer treatment center") or proper name using the search boxes or you can browse through directory lists using the "Find a Person" and "Find a Place" selections. To find a place that provides cancer treatment services, for example, you can:

• Go to "Find a Place"
• Click the link for "Specialty Centers"
• Navigate through the "Specialty Centers" list (it's arranged in A-Z order) to "Cancer Treatment"
• Click the link to view results for places that provide these types of services near your location

You can search for people by specialty ("physical therapy") or proper name using the search boxes or you can browse the directory using the "Find a Person" selections. To find a Physical Therapist, or another health care professional that is not a doctor, dentist, eye doctor, or mental health professional you can:

• Go to "Find a Person"
• Click the link for "Other Health Care Professionals"
• Navigate through the "Other Health Care Professionals" list (it's arranged in A-Z order) to "Physical Therapist"
• Click the link to view results for physical therapists near your search location

You can find information on Ophthalmologists and Optometrists in the health care professionals directory. For other eye care services (lenses, frames, routine eye exams, etc.) you will need to search the Cigna Vision Directory. There are two ways to access vision services:

• If you have Vision coverage and you are logged in to myCigna, browse to "Find a Person" and click on "Eye Doctor." From the "Find an Eye Doctor" directory page you can choose among a few vision specialties to search for or you can view a more comprehensive Cigna Vision Directory.
• If you don't have Vision coverage, you can still search for Vision care professionals and services in the directory on Cigna.com using the directions above. Note: If you don't have Vision coverage, any services you receive will not be covered.

You can get consistent, relevant, and timely information about your plan any time that's convenient for you by:

• Logging in to your myCigna account from cigna.com to find contact information
• Calling us on the phone and talking to a Customer Service representative
• Talking to us through our automated telephone system

For more information, please call Cigna Customer Service at the toll-free number on your Cigna ID card.

Custom Network Directories differ, so there is no simple answer. Your employer may have very specific requirements for using one or the other. If you have questions about which directory to use or how to use your Custom Network Directory, contact your employer's health plan administrator before seeking services.

When you do a search, your search results will be sorted by quality first, if available. Otherwise, they may be sorted according to cost estimates and distance. A sorting drop-down menu located at the top of your results list will indicate how your results are initially sorted. You can then use the drop-down to re-sort the results based on the sorting options available.

Cigna Care Designation (CCD) gives a special status to medical specialists who meet certain quality and efficiency guidelines and who practice in one of these specialties:

• Allergy/Immunology
• Cardiology
• Cardio-Thoracic Surgery
• Dermatology
• Ear/Nose/Throat (Otolaryngology)
• Endocrinology
• Family Practice
• Gastroenterology
• General Surgery
• Hematology/Oncology
• Internal Medicine
• Nephrology
• Neurology
• Neurosurgery
• Obstetrics/Gynecology
• Ophthalmology
• Orthopedics
• Pediatrics
• Pulmonary Medicine
• Rheumatology
• Urology

Yes, but you may pay more. If your plan includes Cigna Care Designation coverage (check to see if "Cigna Care Network" is printed on your ID card), and you need care in one of the network specialties (see "What is the Cigna Care Designation?" FAQ for the list), here's what will happen when you receive covered services:

• If the doctor is a Cigna Care Designation specialist, you receive the services at the in-network coverage level and the amount you pay yourself will be less.
• If the doctor is a Cigna participating health care professional who is not a Cigna Care Designation specialist, you receive the services at the in-network coverage level but the amount you pay yourself will be more.

Participating specialists are evaluated every two years for the Cigna Care Designation.

Cigna Care Designation is awarded to individual participating doctors in one of the following reviewed specialties based on the following criteria:

• Recognized by the National Committee for Quality Assurance (NCQA) for diabetes, cardiac, back pain, heart/stroke care, Physician Practice Connections or Physician Practice Connections - Patient Centered Home.
• Participating bariatric surgeons who performed surgery at one of the Certified Hospitals for Bariatric Surgery and who met our selection criteria.
• Participating specialists in certain specialties and with sufficient patient volume to be evaluated for providing quality care. The measures used for the evaluation are endorsed by the following organizations or developed by physician organizations:
• Ambulatory Care Quality Alliance (AQA)
• National Quality Forum (NQF)
• Health Plan Employer Data and Information Set (HEDIS)

Specialists who perform in approximately the top 33 percent in the market for these measures receive the CIGNA Care Designation. Designation is also awarded to participating doctors' groups/practice in one of the reviewed specialties that has at least one MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) in the group and:

• Meets the Cigna group board certification criteria and performs in the top third within the market for quality measures, or
• Meets the Cigna group board certification and the Cost-Value score is better than the market requirement for the reviewed specialty.

Cigna identifies hospitals as Centers of Excellence (COE) when they achieve the highest scores for cost efficiency (cost value) and effectiveness in treating certain procedures/conditions (patient outcomes, or results of care), based on publicly available patient data. This is a partial evaluation of hospitals based on the patient outcomes (results of care) and cost-efficiency (cost value) information for the selected surgical procedures and medical conditions.

This is provided as an informational tool only and you should not use it as the sole source for making a health or medical decision. Talk to your personal doctor when you are choosing a hospital. Even though a hospital is not rated as a COE, it may still provide quality medical care.

Not all hospitals are rated Cigna Centers of Excellence (COE). Many factors affect Cigna's ability to rate a hospital as a Center of Excellence, including but not limited to:

• Not enough patient volume
• The selected procedure or condition is not performed or treated at the hospital
• Hospital has requested that its cost information not be shared, eliminating it from COE consideration.

Any of the above can affect both patient outcomes and cost effectiveness measurements and Cigna's ability to make a quality rating.

Even though your hospital is not identified as a Center of Excellence it may still provide you and your family with quality medical care and services. The Cigna hospital ratings are provided for informational purposes only and should not be used as the sole source for making a health or medical decision. Always consult with your primary doctor when making decisions that affect your medical care, including choice of hospital.

Yes, your plan does pay a significant portion of your costs, depending on your coverage. For example:

• If you have a deductible, you are required to pay that amount before your plan begins to pay. If you have a high deductible, the amount you owe could be significant.
• Your coinsurance is a percentage of the cost you are responsible for paying even after your plan pays. You might imagine how higher or lower costs could affect what you are required to pay in coinsurance.

Cost estimates may help inform you about the differences in health care costs, which is why we recommend you to log in to myCigna to see your personalized cost estimates. The more well informed you are, the better prepared you are to make educated choices when it comes to choosing a doctor or services. These are informational tools only and you should not use them as the sole source for making a health or medical decision.

Costs can vary based on a number of factors, including:

• The actual services received
• The complexity of the case
• Your plan type (actual costs can vary by plan type)
• Whether costs changed since the date of the estimate.

Also some hospitals consistently care for more seriously ill patients than do others, which can also affect hospital cost information.

You should be aware that the cost ratings information you may see in the search results for a medical procedure may be affected by a variety of factors. These can include:

• Geographic cost differences (for example, major metropolitan areas typically have higher costs as compared to more rural areas)
• Cost information we use to calculate the national average cost (we generally use the rate that applies to one of our product lines; that rate may not apply in your particular case)
• Rates that a hospital charges
• Average time spent in the hospital for the procedure.

Please note that just because a procedure has a better cost rating, it doesn't always mean that having the procedure at that hospital will cost you less.

Information about doctors and other health care professionals is updated at least once every 15 days. Information may have changed since the last update.

If you see incorrect information listed for your doctor you can call Customer Service at the toll-free number to report it or to provide correct information: 1.800.244.6224. Note: If you call to correct information, it could take up to 15 days before it's changed in the system.