Important Health Care Provider Directory Information, Federal and State-Specific Requirements

While reviewing the information on this page, it's important to note:

1. The disclosures provided here are general and your policy, service agreement or other plan documents may contain additional disclosures which are required by your state and/or specific to your plan. Be sure to read the disclosures in your policy, service agreement or other plan documents.

2. Certain mandates may only apply to certain policies or plan types.

3. State mandates may not apply to employer-funded (or self-insured) group plans. Please contact your plan sponsor if you need to know whether your plan is self-insured and whether any state mandates apply to your plan.

The information on this page is subject to change.

Medical plans insured and/or administered by Cigna, as well as certain other health plans offered through third parties, include access to the Cigna LifeSOURCE Transplant Network^®. This is a national network of respected organ and tissue transplant providers, including hospitals and medical centers.

Provider participation in this network is subject to change. To ensure you get the most from your health plan benefits, you should confirm network participation and the coverage terms of your specific medical plan prior to receiving treatment from any provider.

Depending on the terms of your specific medical plan:

1. In some instances, a travel benefit is offered as a feature of the program.

2. You may need a referral from your Primary Care Provider (PCP) to receive coverage for treatment from a transplant specialist.

3. You or your provider may need to obtain prior authorization from the health plan before receiving treatment to get the most from your plan benefits.

4. Your plan coverage may vary depending on the type of transplant procedure and if the participating hospital or other provider is designated a “Program of Excellence” for that procedure.

You are encouraged to review your plan documents and contact your health plan carrier for the details and requirements under your specific medical plan.

If your plan includes access to the Cigna LifeSOURCE Transplant Network, please visit the following website for more information about this network, including a list of participating providers: https://cignalifesource.com/

You can also contact the Cigna LifeSOURCE Transplant Network service center at 1 (800) 668-9682 to speak with a program representative. If you are already receiving care through this network and have questions, please call your health plan carrier or case manager for assistance.

Cigna pays health care providers in ways that are intended to emphasize preventive care, promote quality care and ensure the appropriate and cost-effective use of covered medical services and supplies. Cigna reinforces this philosophy through utilization management decisions made by its medical directors and Health Services staff, when applicable. Cigna employees are encouraged to promote appropriate utilization of covered health care services and to discourage under-utilization.

The same rules apply for health care providers eligible to receive additional payments based on their performance. Provider’s pay and incentives encourage medically necessary care. Cigna considers the provider’s quality of care, quality of service and appropriate use of medical services prior to awarding any bonuses and incentives.

The methods by which participating health care providers agree to be paid are described generally here. The amount and type of payment a health care provider agrees to accept may vary depending upon the type of plan. For example, a provider may agree to accept less for services provided to their patients enrolled in a Health Maintenance Organization (HMO) plan than to patients enrolled in other types of plans.

The following sections provide additional information on how Cigna pays health care providers for covered services:

Discounted Fee-For-Service

Payment for services is based on an agreed-upon discounted amount from the health care provider’s bill.

Capitation

By mutual agreement, network doctors, provider groups or physician/hospital organizations (PHOs) are paid a fixed amount (capitation) at regular intervals for each customer assigned to the provider, group or PHO, whether or not services are provided. This payment covers doctor and/or, where applicable, hospital or other services covered under the plan. Medical groups and PHOs may in turn pay health care providers using a variety of methods.

Capitation offers health care providers a predictable income and encourages those providers to keep people well through preventive care. It eliminates the financial incentive to provide services that will not benefit the patient and reduces paperwork.

Health care providers paid on a capitation basis may participate in a risk-sharing arrangement with Cigna; they agree on a target amount for the cost of certain services and share all or some of the amount whether costs are over or under the target.

Health care services are monitored using criteria that may include accessibility, quality of care, customer satisfaction and appropriate and cost-effective use of medical services and supplies.

Cigna may also work with third parties that administer payments to participating health care providers. Under these arrangements, Cigna pays the third party a fixed monthly amount for these services. Health care providers are compensated by the third-party for services provided to plan participants from the fixed amount. Payment arrangements vary but generally depend on overall utilization.

Salary

Doctors and other health care providers who are employed to work in a Cigna staff-model medical facility are paid a salary. The salary is decided in advance each year and is guaranteed regardless of the services provided. Doctors are eligible for a bonus at the end of the year based on performance, which is evaluated using measurements that may include quality of care, quality of service and appropriate and cost-effective use of medical services and supplies.

Bonuses and Incentives

Some health care providers may receive additional payments based on their performance, which measures quality of care, quality of service and appropriate and cost-effective use of medical services and supplies. Health care providers may also receive financial and/or non-financial incentives that promote utilization of cost-effective participating health care providers (such as hospitals, labs, specialists and vendors) and covered drugs and supplies.

Per Diem Payments to Hospitals

A specific amount is paid to a hospital per day for all health care received. The payment may vary by type of service and length of stay.

Case Rate

A specific amount is paid for all health care received in the hospital for a particular hospital stay (such as for a normal maternity delivery). If you would like to find out which payment method applies to services you receive from a hospital or other provider, just ask the provider’s administrative staff. You can also contact your health plan carrier or plan sponsor if you have questions.

Any cost estimates contained in Cigna’s Provider Directories are designed to help you and your family better understand how much you could pay for the various services you’ve searched for. They are not your final cost and should not be relied on to make final decisions about what care you receive. Cigna works hard to help ensure cost information is as up-to-date and relevant as possible, but we cannot guarantee or warrant accuracy. The amount you will owe could be different based on a variety of factors beyond our control (your plan design, your coverage, claims you may have in process, the doctor or other health care provider, your out-of-pocket costs to date, your plan deductible, money available in your health care accounts (if applicable), where the service is provided, etc.). These are estimates.

Cigna Corporation is a holding company and is not an insurance or an operating company. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, and not by Cigna Corporation. For Cigna company name information, visit https://www.cigna.com/cignacompanynames/

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center in the United States, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.

What is "balance billing" (sometimes called "surprise billing")?

When you see a doctor or other health care provider in the United States, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network.

"Out-of-network" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care-like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. This could happen when you need anesthesia during a surgery. The surgeon may be in-network, but the anesthesiologist may be out-of-network.

Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You're protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility in the United States the most they can bill you is your plan's in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can't be balance billed for these emergency services. This includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

A state balance billing law may also apply to your health plan. For more information about these protections, please visit the section on FEDERAL and STATE-SPECIFIC NOTICES AND DISCLOSURES.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center in the United States certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. You also aren't required to get out-of-network care. You can choose a provider or facility in your plan's network.

A state balance billing law may also apply to your health plan. For more information about these protections, please visit the section on FEDERAL and STATE-SPECIFIC NOTICES AND DISCLOSURES.

When balance billing isn't allowed, you also have these protections in the United States:

• You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you've been wrongly billed,

Please call Cigna if you get a balance bill. Use the phone number on your ID card. You can also contact the No Surprises Help Desk at 1-800-985-3059 or http://www.cms.gov/nosurprises for more information about your rights under federal law.

A state balance billing law may also apply to your health plan. For more information about these protections, please visit the section on FEDERAL and STATE-SPECIFIC NOTICES AND DISCLOSURES for more information about your rights under state laws.

For Cigna Global Health Benefits^® customers, the federal requirements only apply to plans underwritten by Cigna Health and Life Insurance Company. For all other plans underwritten outside the United States, the federal requirements specified above do not apply. If you are unsure if the federal requirements apply to your plan, please call Cigna. Use the phone number on your ID card.

Transparency in Coverage

I. Important information about your cost estimate

Cost estimates, available on myCigna.com or through Cigna Customer Service, give you an idea of the expected cost of a health care item or service before you get care. (Office visits, procedures, medical equipment, and treatments are some examples of items and services.) Please be aware that cost estimates have limits. Consider these limits before you decide to get the item or service:

1. Estimated costs are as of the date of the estimate. Estimates include several factors, such as how much of your deductible or out-of-pocket maximum you've met. Those numbers can change from day to day, so your actual costs may be different, depending on when you have the service.
2. Actual charges may be higher than the estimate. That could happen if you receive services during your visit than were not included in the estimate. Before and during your visit, ask your provider to confirm which items and services you will receive. Ask for a new cost estimate, if they have changed.
3. This estimate is not a guarantee that the item or service is covered by your health plan. Some services must be approved by your plan before you receive them. Go to myCigna.com to find a list of services that must be pre-approved. You can also call Customer Service at the toll-free number on your ID card.
4. Costs have been decided based on your specific health plan and where you are in meeting your deductible and out-of-pocket maximum as of the date of this estimate. Your health plan does not include copayment help and other third-party payments when calculating how much of your deductible or out-of-pocket maximum you've met.
5. The estimate may not tell you when in-network preventive care items or services are covered at 100 percent.
6. "Balance bills" may not be included in your estimate. If you go to an out-of-network provider, the provider could charge you more than your health plan covers for the service. Then, send you a bill for the difference. This is called balance billing. To avoid balance billing, go to an in-network provider.

II. Prerequisites

• Prior Authorization: Some procedures, treatments, or services must be approved before you have them to be covered by your health plan or to avoid extra charges. This process is called prior authorization. Go to myCigna.com for more information on the prior authorization process and a list of services that commonly need preapproval. You also can call the number on your ID card to speak with a Customer Service Associate 24/7/365.
• Concurrent Review: Your health plan may require a review during a course of treatment to determine whether the plan will continue to cover it. This is called concurrent or ongoing review. The review must happen within a specific time after starting the treatment. If your provider does not submit the treatment plan for concurrent review, your health plan may stop covering it.
• Step Therapy: Your health plan may not pay for higher-cost therapies without evidence that certain lower-cost therapies have not worked for you. This is called step-therapy. That means you may have to try a lower-cost therapy before your plan will cover this particular item or service.

III. What if I need more information?

For more information on your cost estimate or the cost estimator tool, message us on myCigna.com. You also can call us at the toll-free number on your Cigna ID Card. A Customer Service Associate is available to help you 24/7/365. For definitions of common medical and insurance terms, see the glossary on Cigna.com.

Cigna uses hospitalist(s) at the following hospital facilities [PDF]. For more information on Cigna's participating hospitalists, call Customer Service at the number on the back of your Cigna ID card.

REPORT INACCURATE INFORMATION

If you see inaccurate information for a provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or other health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

If you believe you relied upon materially inaccurate, incomplete, or misleading Directory information, you may file a complaint by calling the number or writing to the address on the back of your Cigna ID card.

SELECTING AN IN-NETWORK HEALTH CARE PROVIDER

Depending on your plan type you may be required to select a Primary Care Provider (PCP):

When selecting any provider to obtain health care services, current customers should always refer to the Cigna ID card for help to determine the name of your Cigna network and benefit plan and to identify the health care providers that are in-network for your plan. If you are a potential customer, please refer to the benefit plan and network names included in your enrollment materials.

WORKING WITH YOUR PROVIDER AND REFERRALS

When you choose your Primary Care Provider (PCP) to be your personal healthcare provider, you establish and develop a relationship that remains a reassuring part of your plan. Each covered member of your family can choose his or her own PCP.

• The PCP serves as a "home base" for basic care - a source for advice and direction.
• Your PCP also coordinates your care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• Depending on your benefit plan, referrals from PCPs may still be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan documents for details.
• If 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 at your highest (in-network) benefit level. Refer to your plan documents for details. Check with your PCP or call Cigna Customer Service to learn whether this requirement applies to you.
• Regardless of plan type, your health care provider may need to obtain prior-authorization for selected outpatient procedures, diagnostic testing and or inpatient admissions.
• Behavioral health routine outpatient services are not subject to prior authorization. Generally, behavioral health inpatient and non-routine outpatient services are subject to prior authorization.
• You may designate an OB-GYN as a PCP. Also as part of your plan, you can visit a participating OB/GYN at any time, without a referral, even if your plan requires referrals to other types of specialists. Please note: If your PCP is part of a medical group you may be required to see an OB/GYN who practices in that group for services to be covered. Check with your PCP or call Cigna Customer Service to learn whether this requirement applies to you.
• You may designate a physician extender (non-physicians) such as a Physician Assistant, or an Advanced Practice Nurse practitioner as your PCP.
• You can change your PCP at any time, for any reason.

Timely Access to Care
Cigna is committed to providing you access to care on a timely basis. We follow these standards for access as established by the State of California. If you are not provided care within the following timeframes, please call the number on the back of your Cigna ID card and assistance will be provided to ensure you receive timely access to care.

Medical Access Standards

• Urgent care appointments for services that do not require prior authorization - within 48 hours
• Urgent care appointments for services that require prior authorization - within 96 hours
• Non-urgent appointments for primary care - within 10 business days
• Non-urgent appointments with specialist physicians - within 15 business days
• Triage or screening services by telephone 24 hours per day, 7 days per week - within 30 minutes

Dental Access Standards

• Urgent appointments - within 72 hours
• Non-urgent appointments - within 36 business days
• Preventive dental care appointments - within 40 business days

Routine Vision Access Standards

• Routine (non-urgent) appointments - within 30 calendar days
• Urgent appointments - within 48 hours

Behavioral Access Standards

• Urgent care appointments for services that do not require prior authorization - within 48 hours
• Urgent care appointments for services that require prior authorization - within 96 hours
• Non-urgent appointments for primary care - within 10 business days
• Non-urgent appointments with specialist physicians - within 15 business days
• Triage or screening services by telephone 24 hours per day, 7 days per week - within 30 minutes

LANGUAGE ASSISTANCE and ACCESS

Directory listings include languages other than English (if any), spoken by the health care provider or by an office staff member who the provider has identified as a qualified medical interpreter. However if you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have a hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY ), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el námero de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

We expect our contracted providers to meet all applicable federal requirements for accessibility as specified in the American’s with Disabilities Act (ADA) and its regulations. In general, the ADA requires that health care providers offer individuals with disabilities full and equal access to their health care services and facilities, however there can be some exceptions. In order to ensure a provider’s location meets your own access needs please contact that provider directly before scheduling an appointment to obtain care.

IN-NETWORK VS. OUT-OF-NETWORK HEALTH CARE PROVIDERS

In-Network Costs:

Selecting an in-network provider can reduce your out-of-pocket costs. That means other than your copayment, deductible or coinsurance amounts you should not be responsible for any costs for covered services when you receive them from an in-network provider. In-network providers should not bill you for any other costs for covered services or require you to pay any difference between their billed charges and what Cigna has paid them per their contract. If they do, this is called balance billing. You should not experience balance billing from an in-network provider for any covered service. The copayment, deductible or coinsurance is not considered balance billing.

Out-of-Network Costs:

If your plan includes out-of-network benefits, your out-of-pocket costs may be higher for covered services from an out-of-network provider. If your plan does not include out-of-network coverage, the provider may bill you directly for the full cost of services and you will be responsible for the full costs except in the case of emergency services.

Change in your Provider’s Network Status and your Impacts:

It is important to check that your provider is still in your plan’s network before receiving care. If your provider has a change in participation status and is no longer in-network, you may be subject to the same out-of-pocket, out-of-network costs described above. If you are currently being treated for specific ongoing conditions or are pregnant, continuity of care coverage may be considered for a defined period of time. You must apply for Continuity of Care using the Continuity of Care/Transition of Care Request Form. Please check your benefit plan description or call the Cigna Customer Service at the toll-free number on the back of your Cigna ID card.

Out-of-Network Reimbursement:

Payments made to providers not participating in your Cigna network are in line with industry standards and are based on: the provider’s charges, comparison of charges by other similar providers, and the fees typically paid to an in-network provider, for the same type of covered service in the same geographic region and Medicare reimbursement rates. The fee paid to an out-of-network provider by Cigna is considered to be the Maximum Reimbursable Charge. The out-of-network provider may bill you the difference between their charge and the Maximum Reimbursable Charge in addition to applicable deductibles, copayments and coinsurance.

PROVIDERS AT IN-NETWORK FACILITIES:

Health care services may be provided to you at an in-network health care facility by facility-based providers (such as anesthesiologist, emergency medicine radiologists, and laboratories) who are not in your plan’s network. You may be responsible for payment of all or part of the costs for those out-of-network services in addition to applicable amounts due for copayments, coinsurance, deductibles and non-covered services. For more information or to determine if a provider is in-network, please call Cigna Customer Service at the toll-free number on the back of your Cigna ID card.

SERVICES FROM IN-NETWORK PROVIDERS:

Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at the toll free number on your Cigna ID card to ensure that you can obtain the health care services that you need.

Quality and Cost Ratings
Individual facilities or health care providers may disagree with the methodology used to define the cost ranges, the cost data, or quality measures. Many factors may influence cost or quality, including, but not limited to, the cost of uninsured and charity care, the type and severity of procedures, the case mix of a facility, special services such as trauma centers, burn units, medical and other educational programs, research, transplant services, technology, payer mix, and other factors affecting individual facilities and health care providers.

California Residents-regarding Dental coverage: Treatment for conditions already in progress on the effective date of your coverage are not excluded if otherwise covered under your Patient Charge Schedule (PCS).

REPORT INACCURATE INFORMATION
If you see inaccurate information for a provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

Name, address and specialty of the provider as it is currently displayed (this allows us to identify the provider you are referencing), and information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

If you believe you relied upon materially inaccurate, incomplete, or misleading Directory information, you may file a complaint by calling the number or writing to the address on the back of your Cigna ID card.

To file a complaint related to the accuracy of the provider directory and/or the provider experience contact:

• Colorado Department of Regulatory Agencies Division of Insurance
• Complaints are filed through the Consumer Portal, where you will first need to create an account using an email account and password. The portal is a secure way for consumers to submit insurance complaints and communicate with the Division of Insurance. Once the account is created, you will use the email and password to log into the Consumer Portal.
• Consumer Services Team - 303-894-7490 / 800-930-3745 (outside the Denver Metro area) / DORA_Insurance@state.co.us - Monday - Friday, 8:00 a.m. - 5:00 p.m.

Summary of Provider Selection Standards
As part of our mission to help improve the health, well-being and sense of security of the people we serve, Cigna provides access to quality, cost-effective doctors, hospitals, and other health care providers within our networks.

Cigna selects doctors, hospitals and other healthcare providers based on a variety of standards. These standards include completing a comprehensive credentialing application which includes but is not limited to confirmation of appropriate licensing and training details and admitting privileges. Cigna also has specific quality standards which involve a review of any quality of care or service results or complaints, appropriate office set up and practices and acceptable history relative to all types of investigations and disciplinary actions, among others.

Cigna also complies with all state network adequacy and credentialing requirements.

LANGUAGE ASSISTANCE and ACCESS
Directory listings include languages other than English (if any), spoken by the health care provider or by an office staff member who the provider has identified as a qualified medical interpreter. However if you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have a hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

We expect our contracted providers to meet all applicable federal requirements for accessibility as specified in the Americans’ with Disabilities Act (ADA) and its regulations. In general, the ADA requires that health care providers offer individuals with disabilities full and equal access to their health care services and facilities, however there can be some exceptions. In order to ensure a provider’s location meets your own access needs please contact that provider directly before scheduling an appointment to obtain care.

Name of Network
For current customers, always refer to your Cigna ID card for help to determine the name of your Cigna network and benefit plan or to identify the health care providers that are in-network for your plan. If you are a potential customer, please refer to the benefit plan and network names included in your enrollment materials.

Network Selection Criteria
Cigna contracts with doctors, hospitals, and other providers and facilities so that our customers may have access to cost-effective care. To build our networks, we look at how many primary and specialty care doctors are in a specific area. We also look at hospitals and other health care providers within the geography. This way we can make sure there are enough network providers available to meet your health care needs so that you don’t have to go a long way or spend a lot of time getting there. All doctors and hospitals also must meet certain credentialing requirements and agree to rates with us before joining our network. We don’t use quality or cost measures or member experience to initially select providers.

Important Notice:
The doctors listed in this directory see patients for outpatient (non-hospital) office visits, or in a facility location as shown. The directory also includes information about whether the doctor is taking new patients at the outpatient or facility service location.

Network Selection Criteria
Cigna contracts with doctors, hospitals, and other providers and facilities so that our customers may have access to cost-effective care. To build our networks, we look at how many primary and specialty care doctors are in a specific area. We also look at hospitals and other health care providers within the geography. This way we can make sure there are enough network providers available to meet your health care needs so that you don’t have to go a long way or spend a lot of time getting there. All doctors and hospitals also must meet certain credentialing requirements and agree to rates with us before joining our network. We don’t use quality or cost measures or member experience to initially select providers.

WORKING WITH YOUR DOCTOR

• We encourage you to choose a primary care provider (PCP) to be your personal doctor.
• Your personal provider can serve as a “home base” for basic care-your source for advice and direction.
• Your provider may need to get precertification for certain outpatient procedures, diagnostic testing and inpatient admissions.
• Your personal provider also coordinates your care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• For women’s health care, referrals are not needed for visits to in-network OB/GYNs for covered obstetrical or gynecological services.
• Behavioral health routine outpatient services are not subject to prior authorization. Generally, behavioral health inpatient and non-routine outpatient services are subject to prior authorization.
• When a specialist dentist is required, your general dentist will coordinate care and a referral may be required.

DHMO Access/Access Plus
Choose your Network General Dentist from our dental HMO-type network. The Cigna Dental Care Patient Charge Schedule applies only when covered dental services are performed by your designated Network General Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Make sure you tell us which dental office you have chosen before your treatment begins so your coverage will apply. For the most up-to-date list of network dental offices, visit our website at www.cigna.com.

MULTIPLAN NETWORK SAVINGS PROGRAM
Ask your out-of-network provider if they offer discounts through the Network Savings Program. If you have the MultiPlan Savings Program logo on your Cigna ID card, you may save on out-of-pocket costs.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

Name, address and specialty of the provider as it is currently displayed (this allows us to identify the provider you are referencing), and information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

Language Assistance
If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

Accessibility Requirements

We expect our contracted providers to meet all applicable federal requirements for accessibility as specified in the Americans’ with Disabilities Act (ADA) and its regulations. In general, the ADA requires that health care providers offer individuals with disabilities full and equal access to their health care services and facilities, however there can be some exceptions. In order to ensure a provider’s location meets your own access needs please contact that provider directly before scheduling an appointment to obtain care or you can call Customer Service at the number on the back of your ID card.

Pretendemos que todos nuestros proveedores contratados cumplan con todos los requisitos federales aplicables relativos a la accesibilidad, según lo que se especifica en la Ley de Estadounidenses con Discapacidades (ADA, por sus siglas en inglés) y sus reglamentaciones. En general, la ADA exige que los proveedores de servicios de salud les ofrezcan a las personas con incapacidades acceso pleno e igualitario a sus servicios de salud y centros de atención médica. No obstante, puede haber algunas excepciones. Para asegurarse de que el lugar donde atiende un proveedor satisfaga sus necesidades en cuanto al acceso, comuníquese directamente con ese proveedor antes de programar una cita para recibir atención médica o puede llamar a Servicio al cliente al número que figura en la parte de atrás de su tarjeta de identificación.

Language Assistance
If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider (HCP), please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following:

Name, address and specialty of the HCP as it’s currently displayed (this allows us to identify the HCP you are referencing), and information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

Directory Updates
The online directory is updated often, so visit it often. To get the most up-to-date information about the network providers in your area, use our online directory (www.cigna.com or www.mycigna.com) or call Cigna Customer Service for a printed copy, at the toll-free number on the back of your Cigna ID card or 800.244.6224. In addition, please check with the health care provider before scheduling your appointment or receiving services to confirm he or she is participating in Cigna’s network.

SELECTING A PRIMARY CARE PROVIDER (PCP):

Your plan may require you to choose a Primary Care Provider (PCP). Each covered member of your family can choose his or her own PCP. Even if your plan does not require you to choose a PCP, you can still choose one for yourself and your covered dependents to help coordinate your care. When selecting any provider to obtain health care services, current customers should always refer to the Cigna ID card for help to determine the name of their Cigna network and benefit plan and to identify the health care providers that are in-network for their plan. If you are a potential customer, please refer to the benefit plan and network names included in your enrollment materials. In the event of a true emergency, dial 911 or go to the nearest hospital.

When you choose your Primary Care Provider (PCP) to be your personal healthcare provider, you establish and develop a relationship that remains a reassuring part of your plan.

• The PCP serves as a "home base" for basic care - a source for advice and direction.
• Your PCP also coordinates your care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• Depending on your benefit plan, referrals from PCPs may still be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan documents for details.
• If 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 at your highest (in-network) benefit level. Refer to your plan documents for details. Check with your PCP or call Cigna Customer Service to learn whether this requirement applies to you.
• Regardless of plan type, your health care provider may need to obtain prior-authorization for selected outpatient procedures, diagnostic testing and or inpatient admissions.
• Behavioral health routine outpatient services are not subject to prior authorization. Generally, behavioral health inpatient and non-routine outpatient services are subject to prior authorization.
• You may designate an OB-GYN as a PCP. Also as part of your plan, you can visit a participating OB/GYN at any time, without a referral, even if your plan requires referrals to other types of specialists. Please note: If your PCP is part of a medical group you may be required to see an OB/GYN who practices in that group for services to be covered. Check with your PCP or call Cigna Customer Service to learn whether this requirement applies to you.
• You may designate a physician extender (non-physicians) such as a Physician Assistant, or an Advanced Practice Nurse practitioner as your PCP.
• You can change your PCP at any time, for any reason.

Opioid Use Disorders (OUD)
Health care providers who treat Opioid Use Disorders (OUD) can be located in online directories by searching for "Medication Assisted Treatment (MAT) Provider: Buprenorphine/Suboxone" or "Medication Assisted Treatment (MAT) Provider: Vivitrol". If you would like a printed directory, have questions or need assistance locating an OUD health care provider, please contact Customer Service at the toll-free telephone number listed in your enrollment materials or on your Cigna ID card. If you prefer, you may request assistance from a clinical representative.

Timely Access to Care
Cigna is committed to providing you access to care on a timely basis. We follow these standards for access as established by the District of Columbia. If you are not provided care within the following timeframes, please call the number on the back of your Cigna ID card and assistance will be provided to ensure you receive timely access to care.

Medical Access Standards

• First appointment with a new or replacement Primary Care physician – within 7 business days
• First appointment with a new or replacement provider for Prenatal Care treatment – within 15 business days
• First appointment with a new or replacement providers for Specialty Care treatment – within 15 business days

Behavioral Access Standards

• First appointment with a new or replacement providers for Behavioral Health treatment, including Substance Use Treatment – within 7 business days

Examples of Inappropriate Utilization of Non-Emergent Services

The below two examples illustrate the impact on the amounts paid by a customer and Cigna with respect to inappropriate utilization of non-emergent services and care in a hospital emergency department setting compared to utilization of non-emergent services and care in an urgent care center:

Example 1 (Copayment Plan)

$801.00 – Emergency Room rate example**

$250.00 – Emergency Room Copayment (customer cost share)

$551.00 – Cigna payment


$122.50 – Urgent Care rate example**

$50.00 – Urgent Care Copayment (customer cost share)

$72.50 – Cigna payment


Example 2 (80/20 Coinsurance plan – Deductible Satisfied)

$1,358.50 – Emergency Room rate example**

$271.70 – Emergency Room Coinsurance (customer cost share)

$1,086.80 – Cigna payment


$122.50 – Urgent Care rate example**

$24.50 – Urgent Care Coinsurance (customer cost share)

$98.00 – Cigna Payment

** Rates are examples and may differ based on location chosen and type of service provided.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

If you believe you relied upon materially inaccurate, incomplete, or misleading Directory information, you may file a complaint by calling the number or writing to the address on the back of your Cigna ID card.

LANGUAGE ASSISTANCE and ACCESS
Directory listings include languages other than English (if any), spoken by the health care provider or by an office staff member who the provider has identified as a qualified medical interpreter. However if you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have a hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el námero de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

We expect our contracted providers to meet all applicable federal requirements for accessibility as specified in the Americans’ with Disabilities Act (ADA) and its regulations. In general, the ADA requires that health care providers offer individuals with disabilities full and equal access to their health care services and facilities, however there can be some exceptions. In order to ensure a provider’s location meets your own access needs please contact that provider directly before scheduling an appointment to obtain care.

Referrals
Depending on your benefit plan, referrals from PCPs may still be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan documents for details.

All Cigna plans have adopted an "open access" policy for women’s health care. Referrals are not needed for visits to Cigna participating OB/GYNs for covered obstetrical or gynecological services.

Behavioral health routine outpatient services are not subject to prior authorization. Generally, behavioral health inpatient and non-routine outpatient services are subject to prior authorization.

Your health care provider may need to obtain prior-authorization for selected outpatient diagnostic testing and or inpatient admissions.

DHMO Access/Access Plus
Choose your Network General Dentist from our dental HMO-type network. The Cigna Dental Care Patient Charge Schedule applies only when covered dental services are performed by your designated Network General Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Make sure you tell us which dental office you have chosen before your treatment begins so your coverage will apply. For the most up-to-date list of network dental offices, visit our website at www.cigna.com

Total DPPO/DPPO Advantage/Radius DPPO
For the Dental Office Locator or information about benefits, call 1 (888) Dental-8 (1 (888) 336-8258). This list of participating dentists is subject to change. Prior to making an appointment, please confirm the dentist's network participation either through the dental office or your Connecticut General claim office. Please visit our web site, www.cigna.com.

What does a doctor need to do to be in Cigna’s network?
Before joining the Cigna network of contracted doctors, health care providers must meet Cigna standards through a process called credentialing. We regularly review doctors’ credentials to ensure they continue to meet these standards.

Name of Network
For current customers, always refer to your Cigna ID card for help to determine the name of your Cigna network and benefit plan or to identify the health care providers that are in-network for your plan. If you are a potential customer, please refer to the benefit plan and network names included in your enrollment materials.

Source of Information and Frequency of Validation
Medical health care provider information addressing specialty, hospital affiliations, medical group affiliations, board certification, acceptance of new patients and languages spoken is obtained from an application that is completed and signed by the health care provider/facility (during credentialing). Physician board certification is validated through the American Board of Medical Specialties (ABMS), American Medical Association (AMA) or American Osteopathic Association (AOA). Information on the application is updated when the medical health care provider/facility notifies Cigna of changes or at least every three years.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider (HCP), please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

• Name, address and specialty of the HCP as it’s currently displayed (this allows us to identify the HCP you are referencing), and
• Information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

LANGUAGE ASSISTANCE and ACCESS
If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text
Telephone (TTY), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

Network Selection Criteria
Cigna contracts with doctors, hospitals, and other providers and facilities so that our customers may have access to cost-effective care. To build our networks, we look at how many primary and specialty care doctors are in a specific area. We also look at hospitals and other health care providers within the geography. This way we can make sure there are enough network providers available to meet your health care needs so that you don’t have to go a long way or spend a lot of time getting there. All doctors and hospitals also must meet certain credentialing requirements and agree to rates with us before joining our network. We don’t use quality or cost measures or member experience to initially select providers.

Total DPPO/DPPO Advantage/Radius DPPO
Before joining the Cigna network, health care professionals must meet Cigna standards through a process called credentialing. We regularly review credentials to help ensure they continue to meet these standards.

Network Tiers
Your plan does not have separate tiers of in-network providers. However, if you have the Cigna Care Network, your network may include certain types of specialists with a Cigna Care Designation. When you receive covered services from a designated doctor, the in-network coverage level applies and your copayments or level of coinsurance may be lower than if you chose a non-designated doctor. To learn more about Cigna Care Designation including the cost and quality measures utilized to assess doctors, please click here.

IN-NETWORK VS. OUT-OF-NETWORK HEALTH CARE PROVIDERS
In-Network Costs:
Selecting an in-network provider can reduce your out-of-pocket costs. That means other than your copayment, deductible or coinsurance amounts you should not be responsible for any costs for covered services when obtained from an in-network provider. In- network providers should not bill you for any other costs for covered services or require you to pay any difference between their billed charges and what Cigna has paid them per their contract. If they do, this is called balance billing and you should not experience balance billing from an in-network provider for any covered service except for applicable copayment, deductible or coinsurance.

Out-of-Network Costs:

If your plan includes out-of-network benefits, your out-of-pocket costs may be higher for covered services from an out-of-network provider. If your plan does not include out-of-network coverage, the provider may bill you directly for the full cost of services and you will be responsible for the full costs except in the case of emergency services.

Referrals
Depending on your benefit plan, referrals from PCPs may still be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan documents for details. All Cigna plans have adopted an "open access" policy for women’s health care. Referrals are not needed for visits to Cigna participating OB/GYNs for covered obstetrical or gynecological services. Your health care provider may need to obtain prior-authorization for selected outpatient diagnostic testing and or inpatient admissions.

Source of Information and Frequency of Validation
Medical health care provider information addressing specialty, hospital affiliations, medical group affiliations, board certification, acceptance of new patients and languages spoken is obtained from an application that is completed and signed by the health care provider/facility (during credentialing). Physician board certification is validated through the American Board of Medical Specialties (ABMS), American Medical Association (AMA) or American Osteopathic Association (AOA). Information on the application is updated when the medical health care provider/facility notifies Cigna of changes or at least every three years.

Dental health care provider information addressing specialty, dental office/practice affiliations, acceptance of new patients and languages spoken is obtained from an application that is completed and signed by the health care provider and/or through a third-party vendor. Information is updated when the dental health care provider notifies Cigna, and/or the third-party vendor, of changes or at least every three years. The information viewed on this site, including the Brighter Score and other facility and provider specific information is not intended to be the only or primary means for selecting and evaluating a dentist or comparing dental providers. It is not intended to be relied upon as advice, a recommendation or an endorsement about which facility or provider to select or the quality of the dental treatment that you receive from a facility or provider. You are solely responsible for any and all decisions with respect to your dental treatment. Neither Cigna, its affiliates, nor vendors are responsible for any damages or costs you might incur with respect to your use of this site. Never disregard, avoid or delay in obtaining dental advice from your provider or other health care provider because of something that you have read on this site as the site is not intended to be a substitute for provider dental advice.

The Physician Quality and Cost Efficiency Profiles are intended to provide information that can assist individuals in health care decision-making. This information is a partial assessment of physician quality and cost-efficiency. It should not be used as the sole basis for decision-making as such measures have a risk of error. Individuals with Cigna coverage are encouraged to consider all relevant information and to consult with their treating physician in selecting a specialist.

Some health care providers share with Cigna and/or a third-party vendor the various languages spoken in their offices, and Cigna publishes that information in this directory. The languages listed are not guaranteed by Cigna and are not meant to meet any state or federal laws. Please call the health care provider to confirm the current languages spoken in their office.

Cigna Care Designation (CCD) distinguishes network providers who practice in one of the specialties reviewed and who meet certain quality and cost-efficiency measures.

The online directory is updated often, so visit it often. To get the most up-to-date information about the network providers in your area, use our online directory (www.cigna.com or www.mycigna.com) or call Cigna Customer Service for a printed copy, at the toll-free number on the back of your Cigna ID card or 1 (800) 244-6224. In addition, please check with the health care provider before scheduling your appointment or receiving services to confirm he or she is participating in Cigna’s network.

NETWORK SELECTION CRITERIA

For more than 125 years, Cigna has been committed to building a trusted network of health care providers. The doctors, hospitals, facilities, and other providers we contract with must meet certain credentialing requirements. They must also agree to our billing rates. This helps make sure you have access to quality, cost-effective care. To build our network, we look at how many primary care and specialty doctors are in a specific area. We also look at what hospitals, labs, and other facilities are in that area. Our goal is to build a network that gives you choice and convenient access to treatment and services. Provider networks vary by state and plan and include doctors, hospitals, and health care facilities in your local area. Using an in-network provider will help lower your out-of-pocket costs so you can get the most value out of your plan. We don’t use quality or cost measures or customer experience ratings to choose providers when we first build our network.

MARKETPLACE PROVIDER NETWORK SELECTION CRITERIA

We know that where you go to get care is an important and personal decision. To help you make an informed decision, we provide information about the hospitals and doctors in our network. The information includes data on patient outcomes and cost efficiency. This means we look at the results of the care provided and what the treatment costs.

To evaluate our hospitals, we use a star rating system. In-network hospitals receive a score of one, two or three stars for both patient outcomes and cost efficiency based on 19 procedures/conditions. Each hospital also receives an overall score. Hospitals that attain either six or five stars (three stars for patient outcomes + two stars for cost-efficiency OR three stars for cost-efficiency + two stars for patient outcomes) receive the Cigna Center of Excellence designation for that procedure or condition. To learn more about the Cigna Centers of Excellence (COE) program, visit www.cigna.com

Cigna also reviews patient outcomes and cost data for in-network Primary Care Providers (practitioners, internists and pediatricians) as well as in-network providers in 18 common specialties, including cardiology, dermatology and general surgery. Providers that meet our quality and cost-efficiency criteria earn a Cigna Care Designation (CCD). To learn more about the Cigna Care designation, visit www.cigna.com

Some health care providers speak more than one language. We’ve identified them in the directory. Before visiting a provider, ask about what languages they speak if this is important to you.

REFERRALS
Some Cigna plans may require you to get a referral before you see a specialist. A referral comes from your primary care doctor. Your plan may also require preauthorization. Preauthorization is for hospital admissions and select outpatient services. Review your plan documents or call us at the toll free number on the back of your ID card to find out what your plan requires. All Cigna plans have an "open access" policy for women’s health care. This means you can see a participating OB/GYN for covered obstetrical (maternity) or gynecological (women’s health) services without a referral.

NAME OF NETWORK
You get your Cigna ID card after you enroll. Keep your ID card with you at all times. Show it whenever you visit a health care provider or facility. Always check your ID card if you need help finding the name of your Cigna network and benefit plan. This will help you identify the health care providers that are in-network for your plan. If you don’t have a Cigna ID card, look in your enrollment materials.

REPORTING WRONG INFORMATION
Help us keep the provider directory up-to-date. If you find information about a provider that’s not correct, let us know. Contact us using one of these methods:

By phone: Call (800) 244-6224
By e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

Please have available the name, address and specialty of the provider you’re contacting us about. Include in your comment the information you believe is wrong. We appreciate your taking the time to give us this feedback.

Illinois DOI Office of Consumer Health Insurance
The Illinois Department of Insurance (DOI) Office of Consumer Health Insurance has a toll-free number you can call for information or to report a problem. The number to use is 877.527.9431.

LANGUAGE ASSISTANCE
If you have trouble understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call the Customer Service number on the back of your ID card. If you don’t have (or can’t find) your ID card, please call 1.800.244.6224. If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

If you need help finding a health care provider, call us. Use the number on the back of your ID card, or call 800.244.6224. Our team of customer service and clinical professionals are happy to help.

Important Information
Note: The following applies only if you are covered under a Kentucky insurance policy issued by Cigna.

Know How To Voice Your Concerns Or Complaints
Cigna wants you to be satisfied with your health care plan. That’s why we have a process to help address your concerns, and complaints and an appeal process for you to request review of coverage decisions.

Customer Services Can Help
If you have questions about coverage or services or are experiencing a problem, start by calling Customer Services at the number on your ID card. A representative will try to address your questions or resolve your concerns/complaints during the call, except for requests for review of coverage decisions. If Customer Services cannot resolve your concerns, ask the representative for more information about how to have your concerns addressed.

How To Request An Appeal Of A Coverage Decision
The specific appeal process that applies to you is determined by your plan and applicable state and/or federal rules.

If you request review of a coverage decision, you will receive information in writing about the appeal process. You can also refer to your Certificate of Coverage, Group Insurance Certificate or other plan document, or call Customer Services for additional information.

The general overview below describes the appeal process for Kentucky residents covered under an insurance policy issued by Cigna. Consult your Certificate of Coverage, Group Insurance Certificate or Summary Plan Description for a specific description of the appeal process that applies to you.

To begin the process, send your request for a review or call Customer Services at the number on your ID card. You may authorize a representative or a health care provider to request an appeal on your behalf. Show why you believe the first decision should be reviewed again. Include any documentation that supports your appeal with your written appeal request or promptly after you request an appeal by phone.

Your request will be reviewed by someone who was not involved in the initial decision and who can take corrective action. Decisions will be based upon the terms of your plan. A doctor will conduct any review related to medical necessity, and upon your request, a clinical peer of your treating doctor will conduct the review. An appeals committee consisting of at least three people may convene. You will be notified in advance when the meeting will occur, and you or your representative can present your situation to the committee in person, by phone or in writing. You will be notified of the appeal decision within 30 days of submitting your request. If your situation requires urgent care, the review and response will be handled quickly and completed in 72 hours.

An Independent External Review May Be Available
If you are not satisfied with the decision, an independent external review may be available to you, depending on your plan.

If you are covered under an insurance policy, and the appeal involves a coverage denial decision based on your plan limitations or exclusions, you may ask the Kentucky Department of Insurance’s Coverage Denial Coordinator to review the decision. If the appeal involves a coverage decision based on issues of medical necessity or experimental treatment, or if the Kentucky Department of Insurance has reviewed a coverage denial decision and informs Cigna that it believes a medical issue is involved, you can request independent review by an external review organization, also known in Kentucky as an Independent Review Entity.

If external review is available to you, you will be given instructions on how to request this review after the internal appeal is decided. The decision of the external reviewer will be provided within 21 days of the request, or within 35 days if an extension applies, and is binding upon Cigna but not upon you. If the External Review is handled quickly, a decision will be provided by the external review organization within 24 hours of receiving all the information it needs to conduct the review.

If you are covered under an insurance policy, the Kentucky Department of Insurance may be able to assist you in resolving your dispute. If your plan is self-insured by your employer, your employer may have elected not to offer external review. Ask your employer or check your summary plan description for more options. In most cases, you must complete the Cigna appeal process described above before pursuing arbitration or legal action. You should consider taking advantage of the independent external review that may be available. To learn more about the appeal process, call Customer Services.

Appointments With Participating Providers
When you need to see your doctor, an appointment will customarily be available with a participating health care provider:

• Within 48 hours for urgent care appointments and
• Within 2 weeks for routine primary care appointments.

Any Willing Provider
Certain types of health care providers who meet our enrollment criteria and the terms and conditions for participation participate in our network available to persons covered by insurance policies issued by Cigna.

Participating Providers Will Hold You Harmless
Participating health care providers agree to look solely to Cigna or the entity that funds your health benefit plan for compensation for covered services provided to you. That means that you should not receive a bill from a participating health care provider for any costs other than your copayment, deductible, or coinsurance amounts when you have obtained covered services from a participating health care provider. You will be responsible for charges for services that are not covered.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or other health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A NETWORK HEALTH CARE FACILITY BY FACILITY-BASED PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN. YOU MAY BE RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR THOSE OUT-OF-NETWORK SERVICES, IN ADDITION TO APPLICABLE AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE, DEDUCTIBLES, AND NON-COVERED SERVICES. SPECIFIC INFORMATION ABOUT IN-NETWORK AND OUT-OF NETWORK FACILITY-BASED PHYSICIANS CAN BE FOUND AT THE WEBSITE ADDRESS OF YOUR HEALTH PLAN OR BY CALLING THE CUSTOMER SERVICE TELEPHONE NUMBER OF YOUR HEALTH PLAN.

Telehealth, Telemedicine, Remote Patient Monitoring Coverage:

Cigna standardly covers a variety of Telehealth/Telemedicine services. For general information, please visit Virtual Care (Telehealth) Options | Cigna. For coverage and benefits questions, please call the number on the back of your Cigna ID card or visit MyCigna.com.

The state of Louisiana requires some health plans to cover Remote Patient Monitoring in certain circumstances. To verify if your plan covers Remote Patient Monitoring, please call the number on the back of your Cigna ID card.

Louisiana defines Remote Patient Monitoring as:

The delivery of healthcare services using telecommunications technology to enhance the delivery of health care, including but not limited to all of the following:

(a) Monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, and other condition-specific data, such as blood glucose.

(b) Medication adherence monitoring.

(c) Interactive video conferencing with or without digital image upload.

REPORT INACCURATE INFORMATION

If you see inaccurate information for a health care provider (HCP), please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following:

• Name, address and specialty of the HCP as it is currently displayed (this allows us to identify the HCP you are referencing), and
• Information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

Cost Estimates and Quality Data:
For health care costs for comparable health care services and available quality data for providers please visit the Maine Health Data Organization website at the following link: http://www.comparemaine.org/

WORKING WITH YOUR PROVIDERS
Maine allows Advanced Registered Nurse Practitioners (ARNP) to be PCPs. Depending on your plan you may be able to choose an Advanced Registered Nurse Practitioner who is licensed to practice in ME as your PCP. The provider must be contracted as an in-network physician/provider with Cigna in ME to be qualified as a PCP.

Cigna’s Health Care Provider Directories list the independent doctors and other health care providers who participate in Cigna plan networks. However, they may not participate with all hospitals, health care facilities, physicians or other health care providers that may be in your area. Please see your plan to determine how your financial responsibilities may differ if you choose a provider or a facility that is not included in your plan’s provider network. Additionally, not all health care providers that provide services in a Cigna participating hospital or outpatient facility are in Cigna’s network. We recommend you confirm the Cigna network status of a health care provider before receiving services, in order to make an informed decision about where to obtain services. Examples of hospital or facility based professionals that may not participate in our network include, but are not limited to anesthesiologists, radiologists, pathologists and assistants at surgery.

Most pharmacies in Maine contract with Cigna to allow for 90-day supplies at your local retail store. If you are unsure whether your pharmacy participates, you can call the number on your ID card, or ask your pharmacist if they can process the 90-day supply.

NETWORK SELECTION CRITERIA
Cigna contracts with doctors, hospitals, and other providers and facilities so that our customers may have access to cost-effective care. To build our networks, we look at how many primary and specialty care doctors are in a specific area. We also look at hospitals and other health care providers within the geography. This way we can make sure there are enough network providers available to meet your health care needs so that you don’t have to go a long way or spend a lot of time getting there. All doctors and hospitals also must meet certain credentialing requirements and agree to rates with us before joining our network. We don’t use quality or cost measures or member experience to initially select providers.

REFERRALS
Depending on your benefit plan, referrals from PCPs may still be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan documents for details. All Cigna plans have adopted an "open access" policy for women’s health care. Referrals are not needed for visits to Cigna participating OB/GYNs for covered obstetrical or gynecological services. Your health care provider may need to obtain prior-authorization for selected outpatient diagnostic testing and or inpatient admissions.

Total DPPO/DPPO Advantage/Radius DPPO
Please read this information so you will know from which or what group of dentists in-network benefits may be obtained. Network benefits are available from dentists participating in the Cigna Dental PPO.

LANGUAGE ASSISTANCE
If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224. If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Please check with the health care provider before scheduling your appointment or receiving services or call Cigna Customer Service at the toll-free number on your Cigna ID card to confirm he or she is participating in Cigna’s network.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider (HCP), please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

Name, address and specialty of the HCP as it is currently displayed (this allows us to identify the HCP you are referencing), and information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

Maryland Network Adequacy Referral Notice:

Medical/Behavioral
Maryland Referral to Specialty Care Notice and Your Right to Appeal

Standing Referral for Services Provided by a Participating Specialist
You may ask for a standing (ongoing) referral to a participating, in-network, Specialist if you meet all three of these conditions:

• Your Primary Care Physician thinks, with the Specialist, that you need ongoing care from the Specialist.
• You have a condition or disease that is life threatening, degenerative (worsening), chronic or disabling, and you need specialized medical care.
• The Specialist has expertise in treating your disease or condition.

In order to approve a standing referral, we’ll need a written treatment plan from your Primary Care Physician, the Specialist, and you.

Referral for Services by a Non-Participating Specialist or Non-Physician Specialist (Non-participating means out-of-network. A non-physician specialist means a healthcare professional other than a medical doctor (MD or DO). Examples include an APRN, Physician Assistant, or Chiropractor)

You may ask for a referral to a non-participating Specialist or non-physician Specialist if you meet all three of these conditions:

• Your doctor diagnoses you with a condition or disease that requires specialized health care services or medical care.
• We do not have a participating Specialist or non-physician Specialist in-network that has the professional training and expertise to treat your condition or disease.
• We cannot give you access to a Specialist or non-physician Specialist that has the professional training and expertise to treat your condition or disease without a long wait or having to travel.

We’ll calculate your deductible, copayment, and coinsurance (and pay your claims) for this treatment as if you had seen an in-network, participating provider.

To Request a Referral
Please call Customer Service if you need approval to see a Specialist (either in or out-of-network). We’ll talk with you about your condition and get all of the information we need to make a decision.
If we’re not able to approve your request, we’ll let you know. We’ll make our decision using the information you and your doctor give us. If we can’t approve your request, we’ll send a letter to both you and your doctor. It will explain the reason for the denial and how to appeal the decision. It will also have a number to call if you have questions. Your doctor can also talk with another doctor at Cigna about the decision. We usually make a decision not to approve a referral within two business days from when we get all your information.

Definitions

Adverse Decision - An Adverse Decision is a utilization review determination by Cigna that: a proposed or delivered Health Care Service covered under the insured's contract is or was not Medically Necessary, appropriate, or efficient; and may result in non-coverage of the Health Care Service.

Appeal - An Appeal is a protest filed by an insured, his or her representative or a Health Care Provider with Cigna under its internal Appeal process regarding a Coverage Decision concerning an insured.

Appeal Decision - An Appeal Decision is a final determination by Cigna that arises from an Appeal filed with Cigna under its Appeal process regarding a Coverage Decision concerning an insured.

Compelling Reason - A Compelling Reason includes showing that the potential delay in receipt of a Health Care Service until after the insured or Health Care Provider exhausts the internal Grievance process and obtains a final decision under the Grievance process could result in:

• loss of life;
• serious impairment to a bodily function;
• serious dysfunction of a bodily organ;
• the insured remaining seriously mentally ill or using intoxicating substances, with symptoms that cause the insured to be in danger to self or others; or
• the member continuing to experience severe withdrawal symptoms.

A member is considered to be in danger to self or others if the member is unable to function in activities of daily living or care for self without imminent dangerous consequences.

Complaint - A Complaint is a protest filed with the Maryland Insurance Commissioner involving an Adverse Decision or Grievance Decision concerning the insured; or a protest filed with the Commissioner involving a Coverage Decision.

Emergency Case - Emergency Case means a case involving an Adverse Decision for which an expedited review is required by law.

Grievance - A Grievance is a protest by an insured, his or her representative or a Health Care Provider on behalf of the insured filed with Cigna through its internal Grievance process regarding an Adverse Decision concerning the insured.

Grievance Decision - A Grievance Decision by Cigna is a final determination that arises from a Grievance regarding an Adverse Decision concerning the insured, which was filed with Cigna under its internal Grievance process.

Health Care Provider - A Health Care Provider means: an individual who is licensed under the Maryland Health Occupations Article to provide Health Care Services in the ordinary course of business or practice of a profession, and is a treating provider of the insured; or a Hospital, as defined by Maryland law.

Appeals Grievance Process

Cigna has a one-step Appeals and Grievance Procedure for Coverage Decisions and decisions involving Medical Necessity. To initiate an Administrative Appeal or Medical Necessity Grievance for most claims, you must submit a request for an Appeal or Grievance within 180 days of receipt of a denial notice. If you Appeal a reduction or termination in coverage for an ongoing course of treatment that Cigna previously approved, you will receive, as required by applicable law, continued coverage pending the outcome of an Appeal. Appeals may be submitted to the following address:

Cigna
National Appeals Organization (NAO)
PO Box 188011
Chattanooga, TN 37422

For decisions involving Medical Necessity, a denial notice is the same as an Adverse Decision. Notice of an Adverse Decision must be sent by us within five working days after the decision is made. You should state the reason why you feel your Appeal or Grievance should be approved and include any information supporting your Appeal or Grievance. If you are unable or choose not to write, you may ask to register your Appeal or Grievance by calling the toll-free number on your benefit identification card, explanation of benefits or claim form. If we determine that we do not have sufficient information to complete our review, you will be notified within five working days after the Filing Date of your Grievance and will be assisted by us, without further delay, in gathering the necessary information. Filing Date means the earlier of: five days after the date of mailing or the date of receipt.

We will make a decision and will notify you in writing of our decision, both within 30 calendar days of the Filing Date of your Grievance request, unless you agree in writing to an extension for a period of no longer than 15 calendar days. In the event any new or additional information (evidence) is considered, relied upon or generated by Cigna in connection with the Appeal, Cigna will provide this information to you as soon as possible and sufficiently in advance of the decision, so that you will have an opportunity to respond. Also, if any new or additional rationale is considered by Cigna, Cigna will provide the rationale to you as soon as possible and sufficiently in advance of the decision so that you will have an opportunity to respond.

In no case will written notice of the Grievance Decision be sent later than five working days after the Grievance Decision has been made.

Expedited Medical Necessity Grievance Procedure

An expedited Grievance is available for services that are proposed, but which have not yet been rendered. When requested and when the time frames under this process would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function or would cause you to be a danger to self or others, or would cause you to continue using intoxicating substances in an imminently dangerous manner, we will respond verbally with a decision within 24 hours of the date a Grievance is filed, followed up in writing within one calendar day of the verbal response.

If you request that your Appeal be expedited because the time frames under this process would seriously jeopardize your life, health or ability to regain maximum function or in the opinion of your Physician would cause you severe pain which cannot be managed without the requested services, you may also ask for an expedited external Independent Review at the same time, if the time to complete an expedited Grievance would be detrimental to your medical condition.

THERE IS HELP AVAILABLE TO YOU IF YOU WISH TO DISPUTE THE DECISION OF THE PLAN ABOUT PAYMENT FOR HEALTH CARE SERVICES. The Health Advocacy Unit can help you, your representative, and your health care provider file a complaint with the Maryland Insurance Commissioner. You may contact the Health Advocacy Unit of Maryland's Consumer Protection Division at the following address:

Office of the Attorney General
Consumer Protection Division
Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202
Telephone: (410) 528-1840
Toll Free: 1-877-261-8807
Fax: (410) 576-6571
heau@oag.state.md.us
Or visit their website at
https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx

The Unit can also be reached by calling 410-528-1840 or 1-877-261-8807 (phone), TTY 1-800-735-6372 or 410-576-6571 (fax) or by e-mail at heau@oag.state.md.us.

When you file a Complaint with the Commissioner, you will be required to authorize the release of any of your medical records that may be required to be reviewed in order to reach a decision on your Complaint

MARYLAND NETWORK ADEQUACY REFERRAL NOTICE:

Primary Care Providers– General Dentistry

Through its Network Management Department and Quality Management Programs, Cigna Dental keeps its provider networks up-to-date. This makes sure customers have access to enough independent licensed Network General Dentists in their area so they can get the care they need.

Cigna checks our network on a routine basis to decide if we need to add more dental offices. Cigna Dental also checks the network through customer satisfaction surveys, reviews of complaint and grievance data, and through the company’s Quality Management Program efforts.

If a customer does not have access to a Network General Dentist within 25 miles of their home zip code, or if the customer is not able to get a first or routine appointment within a fair period of time, Cigna Dental will approve fee-for-service benefits from a non-participating dentist. This lets a customer get covered benefits from an out-of-network dentist at no extra charge to the customer.

The customer may call Cigna Customer Service for prior approval for in-network benefits at a non-contracted general dentist. If we confirm there is a network adequacy issue (meaning there aren’t enough in-network dentists), we will document the problem in our system and we’ll pay the covered services. Cigna Dental standard utilization review guidelines and processing timeframes (30 days retrospective, 10 days prospective) will apply in making coverage determinations.

Network adequacy issues can also be resolved after the out-of- network claim has been processed. The change will be made once the customer has told Cigna Dental of the network adequacy issue and it has been confirmed. All claim adjustments will be done within 72 hours of request.

The customer will be responsible for his/her Patient Charge based on the correct Patient Charge Schedule. Cigna Dental will pay the difference between the dentist’s usual charge and the customer’s Patient Charge for covered services performed at the non-network general dentist office. This will make sure that the customer’s copay will be no higher than if they had gone to an in-network general dentist.

Specialty Care Providers and Referral Process

Your Network General Dentist (at your dental office) has first responsibility for your professional dental care. Because you may also need specialty care, the Cigna Dental Network includes these types of specialty dentists:

• Pediatric Dentists – Children’s dentistry.
• Endodontists – Root canal treatment.
• Periodontists – Treatment of gums and bone.
• Oral Surgeons – Complex extractions and other surgical procedures.
• Orthodontists – Tooth movement.

There is no coverage for referrals to prosthodontists or other specialty dentists not listed above.

The Network General Dentist, in line with Cigna Dental policies and procedures, may refer a customer directly to a Network Specialty Dentist for needed specialty care. When specialty care is needed, your Network General Dentist must start the referral process. X-rays taken by your Network General Dentist should be sent to the Network Specialty Dentist. Cigna Dental customers can reach out to a Network Pediatric Dentist or Orthodontist directly with no referral.

Cigna also monitors and checks the network of specialist dentists to decide if we need to add more specialist offices. In addition, Cigna Dental checks the network through customer satisfaction surveys, reviews of complaint and grievance data, and through the company’s Quality Management Program efforts.

In the event there is no Network Specialist Dentist within 25 miles of a customer’s home or work, or no Network Specialist with appropriate training to address the customers dental needs, or if the customer is not able to get a first or routine appointment within a fair period of time, Cigna Dental will approve payment for treatment by a non-participating specialist, at no extra cost to the customer.

The customer may call Cigna Customer Service for prior approval for in-network benefits at a non-contracted (out-of-network) general dentist. If we confirm that we have a network adequacy issue, we will document it in our system and we’ll pay the covered services. Cigna Dental standard utilization review guidelines and processing timeframes (30 days retrospective, 10 days prospective) will apply in making coverage determinations.

Network adequacy issues can also be resolved after the out of network claim has been processed. The change will be made once the customer has told Cigna Dental of the network adequacy issue and it has been confirmed. All claim adjustments will be done within 72 hours of request.

The customer will be responsible for his/her Patient Charge based on the correct Patient Charge Schedule and Cigna Dental will pay the difference between the dentist’s usual charge and the customer’s Patient Charge for covered services performed at the non-network specialist office. This will make sure that the customer’s copay will be no higher than if they had gone to an in-network specialist dentist.

Definitions

Appeal - An Appeal is a protest filed by an insured, his or her representative or a Health Care Provider with Cigna under its internal Appeal process regarding a Coverage Decision concerning an insured.

Adverse Decision - An Adverse Decision is a utilization review determination by Cigna that: a proposed or delivered Health Care Service covered under the insured's contract is or was not Medically Necessary, appropriate, or efficient; and may result in non-coverage of the Health Care Service.

Appeal Decision - An Appeal Decision is a final determination by Cigna that arises from an Appeal filed with Cigna under its Appeal process regarding a Coverage Decision concerning an insured.

Complaint - A Complaint is a protest filed with the Maryland Insurance Commissioner involving an Adverse Decision or Grievance Decision concerning the insured; or a protest filed with the Commissioner involving a Coverage Decision.

Coverage decision - the first decision by Cigna Dental that results in non-coverage of a dental procedure; a decision that a person is not eligible for coverage under the plan; or, a decision that results in the cancellation of an individual's coverage under the plan. It also includes non-payment of all or any part of a claim. A coverage decision does not include an Adverse Determination.

Emergency Case - Emergency Case means a case involving an Adverse Decision for which an expedited review is required by law.

Grievance - A Grievance is a protest by an insured, his or her representative or a Health Care Provider on behalf of the insured filed with Cigna through its internal Grievance process regarding an Adverse Decision concerning the insured.

Grievance Decision - A Grievance Decision by Cigna is a final determination that arises from a Grievance regarding an Adverse Decision concerning the insured, which was filed with Cigna under its internal Grievance process.

Urgent Medical Condition - A condition that meets either of these two scenarios:

1. A situation where, without medical care within 72 hours, you:
   • Place your life or health in serious danger;
   • Are not able to get back your normal bodily function;
   • Risk serious harm to bodily function; or
   • Risk serious dysfunction to your bodily organs or parts.
2. A situation where, without medical care within 72 hours, you could suffer bad pain that needs treatment by a health care provider.

Appeals Grievance Process

Cigna Dental has a one-step Appeals and Grievance Procedure for Coverage Decisions and decisions involving Medical Necessity. To initiate an Administrative Appeal or Medical Necessity Grievance for most claims, you must submit a request for an Appeal or Grievance within 180 days of receipt of a denial notice. Appeals may be submitted to the following address:

Cigna Dental Appeals
PO Box 188047
Chattanooga TN 37422

If your appeal or grievance concerns a denied predetermination, Cigna Dental will send you a final decision in writing. It will go to you and any provider acting on your behalf, within 15 calendar days after we get your appeal or grievance. For appeals or grievances concerning rendered services, Cigna Dental will send you a final decision in writing, to you and any provider acting on your behalf, within 30 calendar days after we get your appeal or grievance. If we need more time (or information) to make the decision, we will tell you in writing. We'll let you know we are going to need more time of up to 15 calendar days. We'll also let you know about any extra information we need to finish the review.

Expedited Medical Necessity Grievance Procedure

An expedited Grievance is available for services that are proposed, but which have not yet been rendered. When requested and when the time frames under this process would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function or would cause you to be a danger to self or others, or would cause you to continue using intoxicating substances in an imminently dangerous manner, we will respond verbally with a decision within 72 hours of the date a Grievance is filed, followed up in writing within one calendar day of the verbal response.

Complaint to the State

If you're not satisfied with this decision, you, your representative or your health care provider on your behalf have the right to file a complaint with the Maryland Insurance Commissioner within four months of receipt of this decision. When filing a complaint with the Commissioner, you or your representative will be required to authorize the release of any medical records that may be required to be reviewed for the purpose of reaching a decision on the complaint. The Maryland Insurance Commissioner may be contacted at:

Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202-2272
Telephone: (410) 468-2000
Toll Free: 1-800-492-6116
TTY: 1-800-735-2258
Fax: (410) 468-2270

THERE IS HELP AVAILABLE TO YOU IF YOU WISH TO DISPUTE THE DECISION OF THE PLAN ABOUT PAYMENT FOR HEALTH CARE SERVICES. The Health Advocacy Unit can help you, your representative, and your health care provider file a complaint with the Maryland Insurance Commissioner. You may contact the Health Advocacy Unit of Maryland's Consumer Protection Division at the following address:

Office of the Attorney General
Consumer Protection Division
Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202
Telephone: (410) 528-1840
Toll Free: 1-877-261-8807
Fax: (410) 576-6571
heau@oag.state.md.us
Or visit their website at
https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx

Cigna provider directories list network contracted providers; however, coverage of services vary by plan. Please review your benefits on myCigna.com, your Summary Plan Description or call Cigna to determine if specific services are covered by your plan.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or other health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

YOUR SUMMARY OF BENEFITS
Your Summary of Benefits explains what your plan covers. It includes information about what medical benefits you have. It also shows you what services your plan covers. Read this information so you know whether you have prescription drug coverage, coverage for mental health and substance use, and/or vision care coverage as a part of your Cigna plan. Call Cigna customer service at toll-free at 1.800.Cigna24 (1.800.244.6224) if you have questions about your coverage.

Insured MA Groups-Dental PPO Network
Insured MA Groups-PPO Program: The provider network for this Preferred Provider Plan is available in all of Massachusetts except Dukes and Nantucket County.

We encourage you to choose a Primary Care Physician/Provider (PCP) to be your personal healthcare provider.

• Your PCP can serve as a “home base” for basic care - your source for advice and direction.
• Your PCP also coordinates your care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• Massachusetts allows Physician Assistants and Advanced Registered Nurse Practitioners (ARNP) to be PCPs, depending on your plan you may be able to choose a Physician Assistant or an Advanced Registered Nurse Practitioner who is licensed to practice in MA as your PCP. The provider must be contracted as an in-network physician/provider with Cigna in MA to be qualified as a PCP.
• When you see a Physician Assistant or an Advanced Registered Nurse Practitioner as your PCP you’ll pay only the PCP copay if your plan has copayments, or the visit will be subject to the (in-network) deductible and/or coinsurance of the medical plan in which you are enrolled. The copay is the amount you pay toward an office visit. The coinsurance is the amount you pay after you plan begins to pay.
• If you need help finding a Physician Assistant or an Advanced Registered Nurse Practitioner in our network to serve as a PCP or have any questions as to your plan and the appropriate copayment, please contact the Customer Service number on the back of your ID card.

See How Health Care Providers Are Compensated

ABOUT OUR LOCALPLUS DIRECTORY

The Cigna LocalPlus^® plan provides access to a smaller network than Cigna’s OAP network. You have access to in-network benefits only from LocalPlus network providers when in a LocalPlus network service area. To get the most out of your health care plan, you should see a doctor or facility participating in the LocalPlus network if you are in an area where a LocalPlus network exists.

If you’re away from home and need care, just look for a participating LocalPlus provider in the area or if one isn’t available, you can use providers in our Away From Home Care feature.

If you choose to go outside the LocalPlus Network when one is available (or outside the Away From Home Care feature when LocalPlus isn’t available), you will receive out-of-network coverage (with LocalPlus IN plans, you will pay the full cost of out-of-network care). You have nationwide in-network coverage in case of an emergency. See your plan documents for cost and coverage details.

An updated listing of doctors and other health care providers who participate in the Cigna LocalPlus network and in the Cigna OAP network is always available through this online directory. You can use our online directory to:

• search for participating physicians, hospitals and other health care providers.
• download your own personalized directory to have on hand when you need it.
• find hospital scores for specific conditions/procedures through Cigna “Centers of Excellence.”

The online directory is updated often, so visit it often. For more information, please call Cigna Customer Service at the toll-free number on your Cigna ID card.

Transitional Care
If your health care provider’s participation under the plan is terminated, the health care provider may continue your course of treatment as long as you remain eligible under the plan, a) through postpartum care related to the delivery if you were in the second or third trimester of pregnancy at time of notice of health care provider’s termination, b) up to 6 months if you have been diagnosed with a terminal illness at the time of termination, or c) up to 90 days after the effective date of termination if you are in an active course of treatment.

Your health care provider shall continue to a) accept as payment for covered services in full the same rates in place prior to termination, b) follow standards for maintaining quality health care and provide all necessary medical information related to your care to Cigna, and c) abide by Cigna’s policies and procedures including utilization review, referrals, preauthorizations and treatment plans.

Minnesota Residents-- regarding Dental coverage: You must visit your selected network dentist in order for the charges on the Patient Charge Schedule (PCS) to apply. You may also visit other dentists that participate in our network or you may visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist’s usual fee. We will pay 50% of the value of your network benefit for those services. Of course, you’ll pay less if you visit your selected Cigna Dental Care network dentist. Call Cigna Customer Service for more information.

For HMO Participants Only
THIS HMO MAY HAVE RESTRICTIONS REGARDING WHICH DOCTORS OR OTHER HEALTH CARE PROVIDERS AN HMO CUSTOMER MAY USE. PLEASE CONSULT YOUR GROUP SERVICE AGREEMENT OR PROVIDER DIRECTORY FOR MORE DETAILS.

NETWORK SELECTION CRITERIA

For more than 125 years, Cigna has been committed to building a trusted network of health care providers. The doctors, hospitals, facilities, and other providers we contract with must meet certain credentialing requirements. They must also agree to our billing rates. This helps make sure you have access to quality, cost-effective care. To build our network, we look at how many primary care and specialty doctors are in a specific area. We also look at what hospitals, labs, and other facilities are in that area. Our goal is to build a network that gives you choice and convenient access to treatment and services. Provider networks vary by state and plan and include doctors, hospitals, and health care facilities in your local area. Using an in-network provider will help lower your out-of-pocket costs so you can get the most value out of your plan. We don’t use quality or cost measures or customer experience ratings to choose providers when we first build our network.

MARKETPLACE PROVIDER NETWORK SELECTION CRITERIA

We know that where you go to get care is an important and personal decision. To help you make an informed decision, we provide information about the hospitals and doctors in our network. The information includes data on patient outcomes and cost efficiency. This means we look at the results of the care provided and what the treatment costs.

To evaluate our hospitals, we use a star rating system. In-network hospitals receive a score of one, two or three stars for both patient outcomes and cost efficiency based on 19 procedures/conditions. Each hospital also receives an overall score.Hospitals that attain either six or five stars (three stars for patient outcomes + two stars for cost-efficiency OR three stars for cost-efficiency + two stars for patient outcomes) receive the Cigna Center of Excellence designation for that procedure or condition. To learn more about the Cigna Centers of Excellence (COE) program, visit www.cigna.com

Cigna also reviews patient outcomes and cost data for in-network Primary Care Providers (practitioners, internists, and pediatricians) as well as in-network providers in 18 common specialties, including cardiology, dermatology and general surgery who participate in our network. Providers that meet our quality and cost-efficiency criteria earn a Cigna Care Designation (CCD). To learn more about the Cigna Care designation, visit www.cigna.com

Some health care providers speak more than one language. We’ve identified them in the directory. Before visiting a provider, ask about what languages they speak if this is important to you.

REPORTING WRONG INFORMATION

Help us keep the provider directory up-to-date. If you find information about a provider that’s not correct, let us know.

Contact us using one of these methods:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:
Please have available the name, address and specialty of the provider you’re contacting us about. Include in your comment the information you believe is wrong. We appreciate your taking the time to give us this feedback.

NAME OF NETWORK

You get your Cigna ID card after you enroll. Keep your ID card with you at all times. Show it whenever you visit a health care provider or facility. Always check your ID card if you need help finding the name of your Cigna network and benefit plan. This will help you identify the health care providers that are in-network for your plan. If you don’t have a Cigna ID card, look in your enrollment materials.

Process for Monitoring on an Ongoing Basis Sufficiency of its Network.
Cigna’s goal is to provide a comprehensive, state-wide network of health care providers to help ensure that you have appropriate access to care, according to access standards. We routinely analyze network needs, and actively recruit and contract with health care providers.

Cigna continues to contract directly with doctors and other health care providers, and also with physician-hospital (PHOs), physician’s organizations (POs), independent practice associations (IPAs), and doctors in federally qualified health care centers in order to conform to the dynamics of the medical community and ensure that the network meets your needs.

Cigna’s health care provider network is large and comprehensive. On occasion, network adequacy is reviewed via geo-access plotting and employer group customer requests. Considerable efforts are directed toward promoting beneficial arrangements with New Hampshire PHOs, IPAs, and POs to help assure the correct mix of health care providers and services are available to you in a quality and efficient manner.

Access and Providing Emergency, Urgent and Specialty Care
Cigna has specific access standards for routine, emergency, urgent and specialty care as listed below:

• Emergency - immediate
• Urgent - within 48 hours (not emergencies, but require prompt attention)
• Routine - 7-14 days or as specified by your treating doctor (preventive care screenings and routine physicals are within 30 days)

There are different standards for pregnancy:

• Obstetric Prenatal Care:
  • High-risk or urgent: Immediately
  • Non-high risk and non-urgent: 1st trimester, within 14 days; 2nd trimester, within 7 days, 3rd trimester, within 3 days
  • Routine and Symptomatic Diagnostic Testing: Within the timeframe specified by your treating doctor. Appointments for symptomatic testing are usually provided in shorter timeframes than routine testing

After hours care: Health care provider provides 24-hour coverage.

Network Adequacy Reports

For each type of health benefit plan offered by the carrier, the current enrollment in this state in the form of a table setting forth the number of enrollees by county of residence and the total number of enrollees statewide.

CGLIC & CHLIC Membership (This file is accessible via a right click on the link, select save target as.. add file extension as .xlsx to download the file)

A description of the network associated with each health benefit plan offered by the carrier, including a list of the network providers who are primary care providers, specialty care practitioners, and institutional providers by license, certification or specialty type and by county and hospital service area

Provider Listing

For each distinct network offered by the carrier, using a network accessibility analysis system such as GeoNetworks or any other system having similar capabilities:

• Maps showing the residential location of covered persons in New Hampshire, primary care providers, specialty care practitioners, and institutional providers; and
• An access table illustrating the relationship between providers and covered persons by county or hospital service area, and also on a statewide basis, including at a minimum:
  • The total number of covered persons;
  • The total number of primary care providers who are accepting new patients;
  • The total number of primary care providers who are not accepting new patients;
  • The percentage of covered persons meeting the primary care provider access standard in Ins 2701.04(b);
  • The percentage of covered persons meeting the specialty care practitioner access standard in Ins 2701.04(c) for each type of specialty care practitioner listed in Ins 2701.04(c)(1);
  • The total number of institutional providers and providers of certain other specialty services specified in Ins 2701.04(d) by type; and
  • The percentage of covered persons meeting the access standard for institutional providers and certain other specialty services in Ins 2701.04(d).

Geo Reports

The health carrier’s procedures for making referrals within and outside its network.

Referrals

We no longer require participating physicians to notify us of referrals to in-network specialty-care providers. However, this is only an administrative change; it does not eliminate the referral requirement.

• Depending on the member’s benefit plan, referrals from PCPs may still be required for specialty-care services to be covered at the highest benefit level.
• PCPs are responsible for providing a written referral to the specialty-care physician, and for noting the referral in the patient’s medical record.
• Specialty-care providers also must note the referral in the patient’s record.

If your patient has a network plan, the PCP must provide a referral for specialty care.

POS plans also require PCP referrals for specialty-care services from participating providers. Members may receive services from non-participating providers without a referral from their PCP. However, there is a strong incentive for members who obtain a referral and remain within the provider network-they’ll enjoy the highest benefit levels for covered services and lowest out-of-pocket expenses.

Referrals are never needed in Open Access, PPO and Indemnity plans. Members may visit any doctor for primary or specialty care.

All Cigna plans have adopted an "open access" policy for women’s health care. Referrals are not needed for visits to Cigna participating OB/GYNs for covered obstetrical or gynecological services.

The health carrier’s process for monitoring and assuring on an ongoing basis the sufficiency of its network to meet the health care needs of persons who enroll in managed care plans.

Perform Open Panel Analysis

Measuring Accessibility of Medical Services

Measuring Availability of Healthcare Providers

The health carrier’s plan for providing services in rural and underserved areas and for developing relationships with essential community providers.

Cigna’s goal is to provide a comprehensive, state-wide providers network which ensures that enrollees have appropriate access to care, in accordance with access standards. The Plan routinely analyzes network needs, and actively recruits and contracts with providers.

The Plan continues to contract directly with physicians and ancillary providers, and also with physician-hospital (PHOs), medical service organizations (MSOs), independent practice associations (IPAs), and physicians in federally qualified health care centers in order to conform to the dynamics of the provider community and ensure that the network meets the needs of the membership.

Cigna’s provider network is comprised of over 2100 physicians and over 450 ancillary providers. The provider network is comprehensive and broad reaching. On occasion, network adequacy is reviewed via geo-access plotting and employer group customer requests. Considerable efforts are directed toward fostering beneficial arrangements with Maine PHOs, IPAs, and MSOs to assure the correct mix of providers and services are available to its health plan enrollees in a high quality and efficient manner.

The health carrier’s method of informing covered persons of the requirements and procedures for gaining access to network providers, including but not limited to the following:

• The process for choosing and changing network providers;
• The process for providing and approving emergency, urgent, and specialty care;
• The identity of all of the plan’s participating providers and facilities, including a specification of those participating providers, if any, that are accessible only at a reduced benefit level; and
• Whether and when referral options are restricted to less than all providers in the network who are qualified to provide covered specialty services.

Emergency Care

Provider directories

The health carrier’s system for ensuring the coordination of care for covered persons referred to specialty physicians, for covered persons using ancillary services, including social services, behavioral health services and other community resources, and for ensuring appropriate discharge planning.

CM-28 CM Interface and Outreach

The health carrier’s process for enabling covered persons to change primary care providers.

Changing PCP

The health carrier’s proposed plan for providing care in the event of contract termination between the health carrier and any of its participating providers, or in the event of the health carrier’s insolvency or other inability to continue operations. The description shall explain how impacted covered persons will be notified of the contract termination, or the health carrier’s insolvency or other cessation of operations, and transferred to other providers in a timely manner.

UM-35 Transition of Care for New Customers

UM-41 Continuity of Care when a Provider Terminates

Coordinating Care To Specialists
Coordinating care to specialists for services including social services, behavioral health services and other community resources and ensuring appropriate discharge planning.

Referrals

Network, and Network Point of Service Plan Participants

• Cigna no longer requires participating doctors to notify us of referrals to in-network specialists. However, this is only an administrative change, it does not eliminate the referral requirement.
• Depending on your plan, referrals from PCPs may still be required for specialty-care services to be covered at the highest coverage level.
• PCPs are responsible for providing a written referral to the specialist, and for noting the referral in your medical record.
• Specialists also must note the referral in the patient’s record.

PCPs must provide referrals for specialty care from participating doctors if you are covered under a Network Plan, or POS plan.

You may receive services from non-participating health care providers without a referral from your PCP. However, there is a strong incentive if you obtain a referral and remain within the Cigna network; you will enjoy the highest benefit levels for covered services and lowest out-of-pocket expenses.

Referrals are never needed in Open Access, PPO and Indemnity plans. Customers may visit any doctor for primary or specialty care.

All Cigna plans have adopted an "open access" policy for women’s health care. Referrals are not needed for visits to Cigna participating OB/GYNs for covered obstetrical or gynecological services.

New Hampshire allows Advanced Registered Nurse Practitioners (ARNP) to be PCPs. Depending on your plan you may be able to choose an Advanced Registered Nurse Practitioner who is licensed to practice in NH as your PCP. The provider must be contracted as an in-network physician/provider with Cigna in NH to be qualified as a PCP.

What Is Case Management?
A Cigna nurse provides assistance in coordinating services between health care providers and across different care settings, such as a hospital, rehabilitation facility and your home. The nurse will also assist with identifying available community resources for services that may not be covered or by providing health care information. Customers may call the number on the Cigna ID card to determine if the services of a Cigna Nurse Case Manager might help.

Transitional Care
There may be times when a health care provider becomes unaffiliated with the Cigna network. In such cases, you will be notified and given assistance in selecting a new health care provider. However, in special circumstances, you may be able to continue seeing your doctor, even though he or she is no longer affiliated with Cigna. If you have a special circumstance for which you have been receiving care, such as a life-threatening illness or degenerative or disabling disease or condition, you may be eligible to receive "transitional care" from that nonparticipating health care provider for up to 90 days.

You may also be eligible to receive transitional care if you are in the second trimester of pregnancy. In this case, transitional care may continue through delivery and postpartum care. Such transitional care must be approved in advance by Cigna, and your health care professional must agree to accept our payment rate and to follow Cigna policies and procedures and quality assurance requirements.

There may be other circumstances where continued care by a health care provider no longer participating in the Cigna network will not be available, such as when the health care provider loses his/her license to practice or retires. Also, if you are a new customer with special circumstances for which you have been receiving care, such as a life-threatening illness or degenerative or disabling disease or condition, you may be eligible to receive "continuity of care" from that non-participating health care provider for up to 60 days.

Please contact the number on the back of your Cigna ID card for additional information and assistance if you have any questions on continuity of care.

Board Certified
Any doctor who has completed medical school, an internship, and a residency in a medical specialty and in addition, has successfully completed an examination conducted by a group (or Board) of peers is board certified.

As of the printing of this directory, 79% of New Jersey doctors contracted with Cigna are board certified in their medical specialty.

Transitional Care
There may be instances in which your health care provider becomes unaffiliated with the Cigna network of participating providers. In such cases, you will be notified and provided assistance in selecting a new health care provider.

However, in special circumstances, you may be able to continue seeing your doctor, even though he or she is no longer affiliated with Cigna. If you have a special circumstance for which you have been receiving care, you may be eligible to receive "transitional care" from that non-participating health care provider for up to 120 days. For customers who are pregnant, you may be eligible to receive continued services through delivery, up to six weeks of post-partum.

You may also elect to continue services for post-operative follow-up care for up to six (6) months, and for oncological treatment or psychiatric treatment for up to one year from a participating health care provider who becomes unaffiliated with the Cigna network.

Such transitional care must be approved in advance by Cigna, and your health care provider must agree to accept our payment rate and to follow Cigna policies and procedures and quality assurance requirements. Continued care will be provided at the same copayment and coverage levels that apply to care received from participating health care providers. Continued care will not be available from a doctor who is subject to disciplinary action by the State Board of Medical Examiners, loses his/her license or retires.

If you are a new customer who has a special circumstance for which you have been receiving care, such as an acute illness, pregnancy or injury for which care started on or before your effective date with Cigna, you may be eligible to receive "transition care" from that non-participating health care provider. This transition care must be approved in advance by Cigna.

Office Of Professional Medical Conduct
The Office of Professional Medical Conduct (OPMC) provides a toll-free number to address inquiries and requests for information about any disciplinary actions against doctors and Physician Assistants. You may contact the OPMC at 1.800.663.6114 Monday through Friday, from 8:30 AM to 5:00 PM.

Board Certified
Any doctor who has completed medical school, an internship, and a residency in a medical specialty and in addition, has successfully completed an examination conducted by a group (or Board) of peer doctors is board certified. As of the printing of this directory, 80% of New York doctors contracted with Cigna are board certified in their medical specialty.

Transitional Care
There may be instances in which your health care provider becomes unaffiliated with the Cigna network. In such cases, you will be notified and provided assistance in selecting a new health care provider.

However, in special circumstances, you may be able to continue seeing your doctor, even though he or she is no longer affiliated with Cigna. If you have a special circumstance for which you have been receiving care, such as a life-threatening illness or degenerative or disabling disease or condition, you may be eligible to receive "transitional care" from that nonparticipating health care provider for up to 90 days.

You may also be eligible to receive transitional care if you are in your second trimester of pregnancy. In this case, transitional care may continue through your delivery and post-partum care. Such transitional care must be approved in advance by Cigna, and your doctor must agree to accept our payment rate and to follow Cigna policies and procedures and quality assurance requirements. There may be additional circumstances where continued care by a health care provider no longer participating in the Cigna network will not be available, such as when the health care provider loses his/her license to practice or retires.

If you are a new customer who has a special circumstance for which you have been receiving care, such as a life-threatening illness or degenerative or disabling disease or condition, you may be eligible to receive "continuity of care" from that non-participating health care provider for up to 60 days. You may also be eligible to receive continuity care if you are in your second trimester of pregnancy. In this case, continuity of care may continue through your delivery and post-partum care. Such continuity of care must be approved in advance by Cigna, and your doctor must agree to accept our payment rate and to follow Cigna policies and procedures and quality assurance requirements. There may be additional circumstances where continued care by a health care provider no longer participating in the Cigna network will not be available, such as when the health care provider loses his/her license to practice or retires.

If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224. If you have a hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone ( TTY ), dial 711 to connect with a TRS operator.

Spanish
Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

In-Network Costs:
Selecting an in-network provider can reduce your out-of-pocket costs. That means other than your copayment, deductible or coinsurance amounts you should not be responsible for any costs for covered services when obtained from an in-network provider. In- network providers should not bill you for any other costs for covered services or require you to pay any difference between their billed charges and what Cigna has paid them per their contract. If they do, this is called balance billing and you should not experience balance billing from an in-network provider for any covered service except for applicable copayment, deductible or coinsurance.

Network Tiers:
Your plan does not have separate tiers of in-network providers. However, if you have the Cigna Care Network, your network may include certain types of specialists with a Cigna Care Designation. When you receive covered services from a designated doctor, the in-network coverage level applies and your copayments or level of coinsurance may be lower than if you chose a non-designated doctor. To learn more about Cigna Care Designation including the cost and quality measures utilized to assess doctors, please click here.

Referrals

• Depending on your benefit plan, referrals from PCPs may still be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan documents for details.
• All Cigna plans have adopted an "open access" policy for women’s health care. Referrals are not needed for visits to Cigna participating OB/GYNs for covered obstetrical or gynecological services.
• Behavioral health routine outpatient services are not subject to prior authorization. Generally, behavioral health inpatient and non-routine outpatient services are subject to prior authorization.
• Your health care provider may need to obtain prior-authorization for selected outpatient procedures, diagnostic testing and or inpatient admissions.

Out of Network Costs
If your plan includes out of network benefits, your out of pocket costs may be higher for covered services than if you had selected an in-network provider. If your plan does not include out of network coverage, the provider may bill you directly for the full cost of services and you will be responsible for the full costs except in the case of emergency services.

Change in your Provider’s Network Status and Your impacts
It is important to check that your provider is still an in-network provider. If your in-network provider has a change in participation status and is no longer an in-network provider, you may be subject to the same out of pocket, out of network costs described above. Upon request, some continuity of care coverage exceptions to this can be considered for customers currently being treated for specific ongoing chronic conditions or pregnancy. These exceptions are for a limited period of time and require that a transition of care form request is completed by the customer. Please check your benefit plan description for these exceptions or call the customer service telephone number on the back of your ID card.

Out of Network Reimbursement
Payments made to health care providers not participating in your Cigna network are in line with industry standards and are based on: the provider’s charges, comparison of charges by other similar providers, and the fees typically paid to an in-network provider, for the same type of covered service in the same geographic region and Medicare reimbursement rates. The fee paid to the non-participating provider by Cigna is considered to be the Maximum Reimbursable charge. The out of network provider may bill you the difference between their charge and the Maximum Reimbursable Charge in addition to applicable deductibles, copayments and coinsurance.

Name of Network
For current customers, always refer to your Cigna ID card for help to determine the name of your Cigna network and benefit plan or to identify the health care providers that are in-network for your plan. If you are a potential customer, please refer to the benefit plan and network names included in your enrollment materials.

Facility Based Providers
Health care services may be provided to you at an in-network health care facility by facility-based providers (such as anesthesiologist, Emergency Room physicians, radiologists, and laboratories) who are not in your health plan. You may be responsible for payment of all or part of the costs for those out of network services in addition to applicable amounts due for co-payments, coinsurance, deductibles and non-covered services. For more information or to determine if a provider is in-network, please call the customer service telephone number on the back of your ID card.

Directory Updates:
Note: This online directory is updated six days per week, excluding holidays, Sundays or interruptions due to systems maintenance, upgrades or unplanned outages.

Oklahoma Residents-regarding Dental coverage: DHMO for Oklahoma is an Employer Group Pre-Paid Dental Plan. You may also visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule (PCS) will not apply. You will be responsible for the dentist’s usual fee. We pay non-network dentists the same amount we’d pay network dentists for covered services. Of course, you’ll pay less if you visit a network dentist in the Cigna Dental Care network. Call Cigna Customer Service for more information.

Directory Updates
The online directory is updated often, so visit it often. To get the most up-to-date information about the network providers in your area, use our online directory (www.cigna.com or www.mycigna.com ) or call Cigna Customer Service at the toll-free number on the back of your Cigna ID card or 800.244.6224. In addition, please check with the health care provider before scheduling your appointment or receiving services to confirm he or she is participating in Cigna’s network.

Provider Networks
When building its networks, Cigna looks at multiple factors including, but not limited to: network adequacy requirements, access standard requirements, ability to meet Cigna’s credentialing standards and local market need.

Authorization and Referral Requirements
An authorization or referral may be required to access some providers.

REPORT INACCURATE INFORMATION

If you see inaccurate information for a health care provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or other health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

Language Assistance and Access
Directory listings include languages other than English (if any), spoken by the health care provider or by an office staff member who the provider has identified as a qualified medical interpreter. However if you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have a hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

We expect our contracted providers to meet all applicable federal requirements for accessibility as specified in the Americans’ with Disabilities Act (ADA) and its regulations. In general, the ADA requires that health care providers offer individuals with disabilities full and equal access to their health care services and facilities, however there can be some exceptions. In order to ensure a provider’s location meets your own access needs please contact that provider directly before scheduling an appointment to obtain care.

WORKING WITH YOUR DOCTOR
We encourage you to choose a Primary Care Physician/Provider (PCP) to be your personal healthcare provider as Rhode Island law requires that Cigna requires that you and your dependents designate a participating primary care provider. However, designation of a primary care provider cannot not be a requirement of enrollment and failure to designate a primary care provider will not be a cause for cancellation of coverage. You can provide this information by calling the number on the back of you Cigna ID card.

• Your PCP can serve as a "home base" for basic care - your source for advice and direction.
• Your PCP also coordinates your care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• Rhode Island allows Registered Nurse Practitioners (ARNP) to be PCPs, depending on your plan you may be able to choose an Advanced Registered Nurse Practitioner who is licensed to practice in RI as your PCP. The provider must be contracted as in-network physician/provider with Cigna in RI to be qualified as a PCP.
• When you see an Advanced Registered Nurse Practitioner as your PCP you’ll pay only the PCP copay if your plan has copayments, or the visit will be subject to the (in-network) deductible and/or coinsurance of the medical plan in which you are enrolled. The copay is the amount you pay toward an office visit. The coinsurance is the amount you pay after you plan begins to pay.
• If you need help finding an Advanced Registered Nurse Practitioner in our network to serve as a PCP or have any questions as to your plan and the appropriate copayment, please contact the Customer Service number on the back of your ID card.number on the back of your ID card.

HMO Participants

Enrolling in Cigna Healthcare of South Carolina, Inc. does not guarantee services by a particular health care provider on this list. If you wish to receive care from specific health care providers listed, you should contact the HMO to be sure that the particular provider is participating in Cigna Healthcare of South Carolina, Inc. on the date you enroll. There is no guarantee that the provider will continue to participate during the entire term of your enrollment in Cigna Healthcare of South Carolina, Inc.

REPORT INACCURATE INFORMATION

If you see inaccurate information for a health care provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or other health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

Network Access Information (This file is accessible via a right click on the link, select save link as.. add file extension as .xlsx to download the file)

NOTICE OF RIGHTS UNDER A NETWORK PLAN (PPO)

Texas Department of Insurance Notice - Preferred Provider Plans

You have the right to an adequate network of preferred providers (also known as "network providers").

• If you believe that the network is inadequate, you may file a complaint with the Department of Insurance.
• If you relied on materially inaccurate directory information, you may be entitled to have an out-of-network claim paid at the in-network percentage level of reimbursement and your out-of-pocket expenses counted toward your in-network deductible and out-of-pocket maximum.

You have the right, in most cases, to obtain estimates in advance:

• from out-of-network providers of what they will charge for their services; and
• from your insurer of what they will pay for the services.

You may obtain a current directory of preferred providers at www.cigna.com or by calling 1 (888) 992-4462 for assistance in finding available preferred providers. If the directory is materially inaccurate, you may be entitled to have an out-of-network claim paid at the in-network level of benefits.

• If you are treated by a provider or hospital that is not a preferred provider, you may be billed for anything not paid by the insurer.

If the amount you owe to an out-of-network hospital-based radiologist, anesthesiologist, pathologist, emergency department physician, neonatologist, or assistant surgeon, including the amount unpaid by the administrator or insurer, is greater than $500 (not including your copayment, coinsurance, and deductible responsibilities) for services received in a network hospital, you may be entitled to have the parties participate in a teleconference, and, if the result is not to your satisfaction, in a mandatory mediation at no cost to you. You can learn more about mediation at the Texas Department of Insurance website:
www.tdi.texas.gov/consumer/cpmmediation.html

NOTICE OF RIGHTS UNDER A NETWORK PLAN (EPO)

Texas Department of Insurance Notice - Exclusive Provider Plans

An exclusive provider benefit plan provides no benefits for services you receive from out-of-network providers, with specific exceptions as described in your policy and below.

You have the right to an adequate network of preferred providers (known as "network providers").

• If you believe that the network is inadequate, you may file a complaint with the Department of Insurance.

If your insurer approves a referral for out-of-network services because no preferred provider is available, or if you have received out-of-network emergency care, your insurer must, in most cases, resolve the non-preferred provider’s bill so that you only have to pay any applicable coinsurance, copay and deductible amounts.

You may obtain a current directory of preferred providers at www.cigna.com or by calling 1.888.992.4462 for assistance in finding available preferred providers. If you relied on materially inaccurate directory information, you may be entitled to have an out-of-network claim paid at the in-network level of benefits.

Texas Open Access Plus (OAP) Introductory State Disclosure

Texas Managed Care Introductory State Disclosure

Texas Service Area Maps and Directories

Participating health care providers and facilities are located throughout the service areas. Look under specific listings in these directories for the addresses of physicians and hospitals that participate in your network.

Texas Managed Care Service Area Maps
Texas East Open Access Flex Network
Texas Houston Flex Network POS
Texas Austin HMO POS
Texas Austin OA Flex Network
Texas Austin OA HMO POS
Texas Corpus Christi HMO
Texas Corpus Christi OA Flex Network
Texas Corpus Christi Open Access HMO
Dallas - Ft. Worth HMO
Dallas OA Flex Network POS
Dallas Open Access HMO/POS
Dallas Open Select HMO
El Paso OA Flex Network POS
TX - Golden Triangle HMO/POS
TX - Golden Triangle OA Flex Network
TX - Golden Triangle HMO/POS
TX - Houston HMO
TX - Houston Kelsey Seybold HMO
TX Houston OA Flex Network
TX Houston HMO/POS
TX San Antonio HMO/POS
TX San Antonio OA Flex Network POS
TX San Antonio HMO/POS
TX Waco HMO/POS
TX Waco Network/POS
TX Waco OA HMO/POS

Texas LocalPlus Service Area Maps
Austin LocalPlus
North Texas LocalPlus
Houston LocalPlus

Texas Open Access Plus (OAP) and Preferred Provider Organization (PPO) Service Area Maps
Texas Western Open Access Plus
Texas Southern Texas PPO
Texas Southern Open Access Plus
Texas Northern PPO
Texas Northern Open Access Plus
Texas Western PPO

Hospitals
Cigna has relationships with leading hospitals. The following hospitals participate in the Cigna Open Access Plus Network.

NOTICE: Although health care services may be or have been provided to you at a health care facility that is a member of the Cigna network used by your health benefit plan, other professional services may be or have been provided at or through the facility by doctors and other health care providers who are not customers of that network. You may be responsible for payment of all or part of the fees for those professional services that are not paid or covered by your health benefit plan.

OB-GYN Care For Network and HMO Plans
You do not need a referral to your OB/GYN for an annual well woman exam. Your Primary Care Physician (PCP) may also provide OB/GYN care.

You can change your PCP at any time, for any reason. In addition, if you have a chronic, disabling or life-threatening illness, you may apply to the Cigna Medical Director to request that your treating specialist become the coordinator of all of your care. In order for the Cigna Medical Director to approve this request, your specialist must participate in the Cigna network and must agree to become coordinator of all your care. Your specialist must agree to meet and accept all Cigna requirements and payment schedules for PCPs, and must sign your request. If you are not satisfied with the Medical Director’s response, you may appeal the response in accordance with the Cigna Complaints and Grievance Policy.

Kelsey Seybold
Important plan information for: The Greater Houston Area
Primary Care Doctors
You may choose your personal primary care physician (PCP) from the following list of Kelsey-Seybold doctors specializing in Family Medicine, Internal Medicine or Pediatrics. Remember, you can select a different doctor for each member of your family. You can directly access any Kelsey-Seybold Clinic specialist (Kelsey-Seybold will appear below the name in the specialist section of the directory) including any participating obstetrician/gynecologist without a primary care physical referral. However, a referral by a Kelsey-Seybold Clinic physician is required for other participating specialists.

Texas Residents-regarding Dental coverage: Treatment for conditions already in progress on the effective date of your coverage are not excluded if otherwise covered under your Patient Charge Schedule (PCS).

Cigna Dental Choice Plan

In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the "Cigna Dental Choice Plan". The Cigna Dental PPO network(s) is a national reference to our network; in Texas this network(s) will be utilized with the Cigna Dental Choice Plan.

Specialists
For Specialty care provided by a Kelsey-Seybold Clinic doctor, you will not need a referral. (In this directory, _Kelsey-Seybold_ appears below the name of Kelsey-Seybold Clinic specialists.) For Specialty care provided by a doctor who is not a Kelsey-Seybold Clinic doctor, you will need a referral. In those situations, your PCP will recommend a participating specialist affiliated with Kelsey-Seybold.

For well-woman exams and obstetrical and gynecological exams, you do not need a referral, and you may visit any participating obstetrician/gynecologist, including those who are not Kelsey-Seybold Clinic doctors, as long as he or she is participating in this network. Please see your Summary of Benefits for information about referrals or other requirements.

Most non-emergency hospital care will be provided at St. Luke’s Episcopal Hospital, St. Luke’s Episcopal Hospital-The Woodlands, Methodist Willowbrook, Methodist Sugar Land, Clear Lake Regional, Woman’s Hospital of Texas (OB/GYN services only) and Texas Children’s Hospital.

PRECERTIFICATION
Our goal is to help make sure that you have access to the appropriate care, in the appropriate setting. We have established a wide network of doctors and we continuously contract with new health care providers to help make sure that you have access to care from credentialed health care providers.

Your plan may require that you choose a Primary Care Physician (PCP) for yourself and your covered dependents. Your PCP is your personal doctor who can coordinate your medical care and keep your medical history. If your plan does not require you to choose a PCP, you can still choose a PCP or a personal doctor for yourself and your covered dependents to help coordinate your care. Your first stop should be your PCP or personal doctor. He or she can help determine if you need specialty care or hospitalization.

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

• Whether a procedure, treatment or service is covered by your plan.
• What your coverage will be for a procedure, treatment or service if you use a health care provider who is not in the Cigna network.

How Does The Process Work?
Your plan may require precertification for hospital admissions and selected outpatient services. When precertification is required, a Cigna nurse evaluates the request using nationally recognized guidelines. These guidelines are consistent with sound clinical principles and processes and have been developed with involvement from actively practicing health care providers. Cigna nurses determine what services are covered based on your plan and using these guidelines. When guidelines do not exist, clinical resource tools based on clinical evidence are used.

Anytime 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 obtain additional information. You and your doctor will be notified in writing if a request for a precertification number cannot be approved based on the information we received and your plan benefits.

When Does The Review Occur?
The review process can occur at three different times:

• Prospective review is when Cigna receives a request before you receive care. Determinations are made within two business days of receiving all necessary information. You and your health care provider will be notified verbally or electronically and by mail.
• Concurrent review is when Cigna receives a request while you are receiving care or in a hospital, skilled nursing facility or rehabilitation facility. Determinations are made within one business day of receiving all necessary information. You and your health care provider will be notified verbally or electronically and by mail
• Retrospective review is when Cigna receives a request after you have received care. Determinations related to these services are made within thirty days after receiving all necessary information. You and your health care provider will be notified verbally or electronically and by mail.

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

Licensed doctors will determine coverage denials when clinical reasons are the reason for the denial. Denial letters will explain the reason for the decision and details on how to submit additional information and/or proceed through the formal Appeals Process, if you disagree with the coverage decision.

If your doctor is part of the Cigna network, then he or she is responsible for contacting Cigna to start the precertification process. If you use a doctor who is not part of the Cigna network, then you are responsible for contacting Cigna to start the precertification process. It is important for you to review your benefit plan or contact Cigna at the number on your Cigna ID card to understand which services require precertification.

Texas Residents-regarding Dental coverage: Treatment for conditions already in progress on the effective date of your coverage are not excluded if otherwise covered under your Patient Charge Schedule (PCS).

Access Requirements for Non-Contracted Providers

You may be entitled to coverage for health care services from the following non-contracted providers if you live or reside within 30 paved road miles of the listed providers, or if you live or reside in closer proximity to the listed providers than to your network of contracted providers. View list of providers [PDF]

Network Selection Criteria
Cigna contracts with doctors, hospitals, and other providers and facilities so that our customers may have access to cost-effective care. To build our networks, we look at how many primary and specialty care providers are in a specific area. We also look at hospitals and other health care providers within the geography. This way we can make sure there are enough network providers available to meet your health care needs so that you don’t have to go a long way or spend a lot of time getting there. All doctors and hospitals also must meet certain credentialing requirements and agree to rates with us before joining our network. We don’t use quality or cost measures or member experience to initially select providers or the networks.

REPORT INACCURATE INFORMATION
If you see inaccurate information for a health care provider (HCP), please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

Name, address and specialty of the HCP as it’s currently displayed (this allows us to identify the HCP you are referencing), and information you believe is inaccurate, such as name (spelling), address, phone number, whether they are accepting new patients, or their participation in a certain network or benefit plan.

Cigna will verify the information you have sent and ensure it is corrected accordingly.

LANGUAGE ASSISTANCE
If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224. If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

If you have questions or need assistance locating a health care provider, please contact Customer Service at the toll-free telephone number listed in your enrollment materials or on your Cigna ID card. If you prefer, you may request assistance from a clinical representative.

What Is Case Management?
Case Management is when a Cigna nurse provides you with assistance in coordinating services between your health care providers and across different care settings, such as a hospital, rehabilitation facility and your home. The nurse will also assist you with identifying available community resources for services that may not be covered by your benefit plan or by providing you with health care information. If you think the services of a Cigna Nurse Case Manager might help you, call the number on your Cigna ID card.

What is Disease Management?
Cigna has programs to assist you with chronic conditions like heart disease, diabetes, and asthma. You can enter a program by calling, or from a referral by your doctor, or by answering your Personal Health Assessment questionnaire with information on a chronic problem. We will call you to talk about your needs, send you reading materials or help you learn more about your condition online. We want you to feel better and do more each day. If you think the services of these programs might help you, call 1-800-Cigna24 (1.800.244.6224).

Standing Referrals
You or your PCP may ask for a standing referral to a specialist or care center if you have a condition or disease that:

• Needs care over a long period of time
• Is life-threatening, degenerative or disabling.

We will give you a standing referral to one of these doctors if your primary care physician (PCP) talks to the doctor and the plan medical director. If they both feel that the special care is medically necessary, a referral will be issued. A treatment plan will be asked for and reviewed.

Specialist Doctor Serving as Primary Care Physician for a Life-Threatening, Degenerative or Disabling Condition
In Vermont, a customer may, upon Cigna approval, use a Specialist as their PCP for a life-threatening, degenerative or disabling condition. The request must include a signed statement from the customer requesting the Specialist to serve as the customer’s PCP and certification from the Specialist of the medical need to serve as the customer’s PCP.

Upon receipt of this documentation:

• A Cigna Medical Director validates the medical necessity of the request.
• A decision is made within 10 business days or less from receiving the request.
• If approved, Cigna will get a signed statement from the Specialist accepting responsibility to serve as the customer’s PCP, coordinate customer care needs and accept the PCP contracted payment rate for primary care services.
• If the Cigna Medical Director denies the request for a Specialist to serve as the customer’s PCP, the denial notification includes the reason(s) for denial, appeal rights and confirmation that the decision was made by a Cigna Medical Director.
• The customer will be notified in writing within 21 to 30 business days of the decision.

Mailing Address:
Cigna
4100 International Pkwy
Suite 1010
Carrollton, TX 75007

Mental Health / Substance Use
These health care providers and services also participate with Cigna.

Cigna believes that needed care should be available to you in a timely way. However, it may take up to 10 business days to be seen by a therapist. It is important to note that a health care provider’s availability to new patients may change frequently. If you feel you need more urgent help or if you need assistance in locating a health care provider, please call the toll free number on the back of your ID card.

Behavioral health routine outpatient services are not subject to prior authorization. Generally, behavioral health inpatient and non-routine outpatient services are subject to prior authorization.

If your provider of mental health or substance use services is not currently listed in this directory, please ask your health care provider if he/she wishes to apply to join the network. Any health care provider willing to meet the terms and conditions for participation in Cigna’s network may apply for contracted status and may become contracted after successful completion of credentialing. The provider application as well as terms and conditions can be found online at: Evernorth Provider - Resources - Credentialing

WORKING WITH YOUR DOCTOR

We encourage you to choose a Primary Care Physician/Provider (PCP) to be your personal healthcare provider.

• Your PCP can serve as a “home base” for basic care - your source for advice and direction.
• Your PCP also coordinates your care - from preventive checkups and routine medical care to specialized care and hospitalizations.
• Vermont allows Naturopathic doctors and Advanced Registered Nurse Practitioners (ARNP) to be PCPs, depending on your plan you may be able to choose a Naturopathic doctor or an Advanced Registered Nurse Practitioner who is licensed to practice in VT as your PCP. The provider must be contracted as in-network physician/provider with Cigna in VT to be qualified as a PCP.
• When you see a Naturopathic doctor or an Advanced Registered Nurse Practitioner as your PCP you’ll pay only the PCP copay if your plan has copayments, or the visit will be subject to the (in-network) deductible and/or coinsurance of the medical plan in which you are enrolled. The copay is the amount you pay toward an office visit. The coinsurance is the amount you pay after your plan begins to pay.
• If you need help finding a Naturopathic doctor or an Advanced Registered Nurse Practitioner in your network or have any questions as to your plan and the appropriate copayment, please contact Customer Service at the number listed on your ID card.

PRECERTIFICATION
Our goal is to help make sure that you have access to the appropriate care, in the appropriate setting. We have established a wide network of health care providers and we continuously contract with new doctors to help make sure that you have access to care from credentialed health care providers.

Your plan may require that you choose a Primary Care Physician (PCP) for yourself and your covered dependents.. Your PCP is your personal doctor who can coordinate your medical care and keep your medical history. If your plan does not require you to choose a PCP, you can still choose a PCP or a personal doctor for yourself and your covered dependents to help coordinate your care. Your first stop should be your PCP or personal doctor. He or she can help decide if you need specialty care or hospitalization.

What Is Precertification?
Precertification is a review process where Cigna nurses, pharmacists and doctors work with your own doctor to decide:

• Whether a procedure, treatment or service is covered by your plan.
• What your coverage will be for a procedure, treatment or service if you use a health care provider who is not in the Cigna network.

How Does The Process Work?
Your plan may require precertification for hospital admissions and selected outpatient services. When precertification is required, a Cigna nurse evaluates the request using nationally recognized guidelines. These guidelines are consistent with sound clinical principles and processes and have been developed with involvement from actively practicing health care providers.

Cigna nurses decide what services are covered under your plan and using these guidelines.

When guidelines do not exist, clinical resource tools based on clinical evidence are used. Anytime 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 obtain additional information. You and your doctor will be notified in writing if a request for a precertification number cannot be approved based on the information we received and your plan benefits.

When Does The Review Occur?
The review process can occur at three different times:

• Prospective review is when Cigna receives a request before you receive care. Decisions are made within two business days of receiving all necessary information. You and your health care provider will be notified verbally or electronically and by mail.
• Concurrent review is when Cigna receives a request while you are receiving care or in a hospital, skilled nursing facility or rehabilitation facility. Decisions are made within one business day of receiving all necessary information. You and your health care provider will be notified verbally or electronically and by mail.
• Retrospective review is when Cigna receives a request after you have received care. Decisions related to these services are made within thirty days after receiving all necessary information. You and your health care provider will be notified verbally or electronically and by mail.

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

Licensed doctors will decide coverage denials when clinical reasons are the basis for the denial. Denial letters will explain the reason for the decision and details on how to submit additional information and/or proceed through the formal Appeals Process, if you disagree with the coverage decision. If you need more information on the Appeal Process you can check your Handbook or certificate or you can contact Cigna at the number on your Cigna ID card.

If your doctor is part of the Cigna network, then he or she is responsible for contacting Cigna to start the precertification process. If you use a doctor who is not part of the Cigna network, then you are responsible for contacting Cigna to start the precertification process. It is important for you to review your plan or contact Cigna at the number on your Cigna ID card to understand which services require precertification.

How Do I Get An Approval?
If your doctor is part of the Cigna network, then he or she is responsible for contacting Cigna to start the precertification process. If you use a doctor who is not part of the Cigna network, then you are responsible for contacting Cigna to start the precertification process.

If you are unable to locate an in-network health care provider in your area who can provide you with a service or supply that is covered under this plan, you must call the number on the back of your ID card to obtain authorization for out-of-network coverage. If you obtain approval for services provided by an out-of-network health care provider, those services will be covered at the in-network coverage level. It is important for you to review your benefit plan or contact Cigna at the number on your Cigna ID card to understand which services require precertification.

Coverage for services performed are not guaranteed until any requirements for utilization review have been completed and authorization has been issued. Please refer to your certificate for information on prior authorizations and consequences if that authorization is not obtained, seeking coverage for services by out-of-network providers or initiating a grievance.

REPORT INACCURATE INFORMATION

If you see inaccurate information for a health care provider, please help us improve your experience by reporting it using one of the following options:

Report by phone: Call (800) 244-6224

Report by e-mail:

Send an email to:

Medical Providers: providerupdates@cigna.com
Dental Providers: DentalProviderDataManagementInbox@cigna.com
Behavioral Providers: BehavioralPDM@cigna.com
Pharmacy Providers: Pharmacynetworkoperations@cigna.com

Include the following information:

1. Doctor, facility or health care provider’s information as it is displayed in the directory (name, address, and specialty)
2. The information you would like to be corrected, such as name, address, phone number, etc.

Thank you! Cigna will verify the information you have provided and ensure it is corrected accordingly.

Language Assistance and Access

Directory listings include languages other than English (if any), spoken by the health care provider or by an office staff member who the provider has identified as a qualified medical interpreter. However if you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help please call the Customer Service number on the back of your ID card. If you do not have or are unable to locate your ID card, please call 1.800.244.6224.

If you have a hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator

Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin costo alguno para usted. Para obtener ayuda, comuníquese con el námero de Servicio al cliente que figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto (TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.

We expect our contracted providers to meet all applicable federal requirements for accessibility as specified in the Americans’ with Disabilities Act (ADA) and its regulations. In general, the ADA requires that health care providers offer individuals with disabilities full and equal access to their health care services and facilities, however there can be some exceptions. In order to ensure a provider’s location meets your own access needs please contact that provider directly before scheduling an appointment to obtain care.

Referrals

Depending on your benefit plan, referrals from PCPs may be required for specialty care services to be covered at your highest (in-network) benefit level. Refer to your plan booklet or contact Customer Service at the phone number on the back of your identification card or 1.800.244.6224 for details.

Virtual Care/Telemedicine/Telehealth

Virtual care (also known as telehealth or telemedicine) is the use of technology to connect with a provider, by video or phone, using a computer or mobile device. Cigna covers a variety of Virtual Care/Telehealth/Telemedicine services. For general information, please visit Virtual Care (Telehealth) Options | Cigna. For coverage, benefit and provider availability questions, please call the number on your Cigna ID card or visit myCigna.com.

Cigna complies with telemedicine mandates. For further details regarding telemedicine, please refer to your plan booklet or contact Customer Service at the phone number on the back of your identification card or 1.800.244.6224.

Gender-Affirming Treatment Providers

If you need assistance locating a gender-affirming treatment provider in your network, please call the number on your Cigna ID card.

When you seek Emergency Room (ER) services

Use the following list to see if the ER Physicians group serving our participating hospitals is In-Network. The cost to you for receiving ER services from an Out-of-Network ER Physicians group may be higher even if you receive services at an In-Network Hospital.

View OAP / PPO WA ER Physician Group Listing
View LocalPlus WA ER Physician Group Listing

Malpractice History and Disciplinary Actions

For information on where to find malpractice history and disciplinary actions for a health care provider, please contact Customer Service at the phone number on the back of your identification card or 1.800.244.6224.

Network Adequacy

You may view the Access Plan, as required by the Health Benefit Plan Network Access and Adequacy Act, online at WV Medical Network Access Plan [PDF]. You may also contact us at the number on the back of your ID card to request a copy.

Important Notice: Preferred Provider Plan Notice To Customers

You are strongly encouraged to contact us to verify the status of the providers involved in your care including, for example, the anesthesiologist, radiologist, pathologist, facility, clinic or laboratory when scheduling appointments or elective procedures to determine whether each provider is a participating or nonparticipating provider...Such information may assist in your selection of provider(s) and will likely affect the copayment, deductible and amount of coinsurance applicable to the care you receive.

The information contained in this directory may change during your plan year. Please contact Customer Services at the number on your ID Card to learn more about the participating providers in your network and the implications, including financial, if you decide to receive your care from nonparticipating providers.