Medically necessary home health care services are available following breast surgery procedures. Following a mastectomy Cigna HealthCare medical plans provide coverage for breast reconstruction when appropriate. Clinical Trials As new drugs are developed for the treatment of a specific illness or condition, they are tested for safety and effectiveness.
Health plan members sometimes request coverage for medical treatment associated with a clinical trial. Clinical trials are not without risks, and each trial needs to be evaluated for potential benefits and risks. Cigna HealthCare reviews requests for coverage of treatment associated with Phase 3 and 4 clinical trials on a case-by-case basis.
Commitment to Quality We promote health by providing:. We measure the effectiveness of our program activities by seeking external validation of our programs. To learn more about our quality management program or to request a report on our progress in meeting our goals, call Customer Service at the number on your Cigna ID card.
This does not apply to Indemnity plans because they are not network-based plans. In a Indemnity plan, members are free to see any provider, so changes in managed care provider networks would not apply. If a contract with a provider participating in a Cigna HealthCare network is terminated or an employer selects a Cigna HealthCare medical plan while an employee is receiving care from a provider who does not participate in a Cigna HealthCare network, we will work with the member to assure that there is continuity of care.
Continuity of care can be accomplished by allowing the member to continue to receive treatment from the current non-participating provider or working to effect the smooth transition of care to a Cigna HealthCare participating provider. We have developed national policies to credential practitioners and facilities that are adopted and managed at the local level by our local medical management staff. Because Indemnity plans are not network-based participants can see any providers they choose , there are no "participating providers", so credentialing does not apply to Indemnity plans.
Cigna HealthCare accessibility and availability standards also apply to our participating providers. Our medical management staff checks:. Also, we regularly survey our managed care plan participants on the delivery and quality of services they receive from the doctors participating in the Cigna HealthCare network. Each Cigna HealthCare Network Plan and POS Plan member selects a primary care physician — usually a family practitioner, internist, or pediatrician, who becomes the cornerstone for that member's health care needs.
For members with complex health conditions, the role of the PCP is essential. Under certain circumstances when it is determined that the ongoing needs of a member with chronic or multiple illnesses would be most effectively met by a specialist, that specialist becomes the primary care provider for that member i.
This decision would be made as part of our case management process, which is an integral part of Cigna health plans. The health care needs of most healthy women at certain stages in their lives are more centered around their reproductive health.
Disclosure Disclosure of information to the consumer has surfaced as a key issue in the public debate over managed care. There is a misperception that health plans do not give their members basic information about the plan such as: what is contained in the benefit plan they have selected, how to access services, which providers are in the network, what is the appeal and grievance procedure, etc.
Consumer advocates and others are interested in requiring health plans to disclose financial information such as: what percentage of each premium dollar goes to the delivery of medical care versus administration of the plan, the specific amount providers are compensated, etc.
We believe that full information disclosure is essential to member satisfaction and in providing access to quality care. Cigna HealthCare members receive a description of their benefit packages that includes information on: exclusions and limitations, the definition of emergency care, claims and reimbursement procedures.
In addition, participants in our managed care Network, POS, EPO, PPO plans receive instructions on accessing primary and specialty care, away-from-home care, out-of-network benefits POS and PPO plans only , member rights and responsibilities, the Cigna HealthCare appeal and grievance procedure, a directory of participating providers, and other important information.
Emergency Room Widespread reports of emergency room claim denials by managed care plans have led to calls for legislative solutions.
EMTALA requires hospitals and emergency room physicians to screen and stabilize emergency room patients regardless of whether the patient is in an emergency situation.
As a result, hospitals and emergency room physicians are often not being paid for these services. They have seized this issue and are seeking legislation that would guarantee payment for all treatment provided in emergency rooms, regardless of the medical necessity of the services.
This proposal would remove the financial disincentive for inappropriate use of the emergency room. In effect, it would encourage people to use the most expensive health care setting, the emergency room, rather than their primary care physician or specialists.
Another issue is that emergency room claims are initially being denied because hospitals and emergency room physicians disclose only the final patient diagnosis on claim forms.
When the presenting symptoms are disclosed, the claims are often paid. Cigna HealthCare goal is to provide quality, coordinated care in the most appropriate setting. Emergencies should be treated in the emergency room, and patients should get emergency care when they need it at the sudden — and unexpected — onset of a serious injury or life-threatening illness.
No Cigna HealthCare participant regardless of plan type Network, POS, EOP, PPO or Indemnity is required to get prior authorization before seeking treatment in an emergency room in a situation in which a "prudent layperson" would believe such emergency care is required. Non-emergency conditions should be treated by a physician in the physician's office.
We encourage all Cigna HealthCare plan participants to seek treatment for non-emergency conditions as soon as possible. Cigna HealthCare, by contract, requires participating primary care physicians to maintain hour, seven-day-a-week telephone coverage and to provide an appointment within 24 to 48 hours of a request for urgent medical conditions.
When members are unsure whether or not they have a condition that requires immediate medical attention, they should consult with their primary care physicians. If their symptoms warrant prompt medical attention, the PCP will refer them to the emergency room.
This relationship facilitates better treatment in the emergency room because the primary care physician can alert the emergency room that the patient is coming and provide important details on the patient's condition and health history. Any hour of the day or night, from any phone in the U. A Health Information nurse will help you determine if emergency room care is advisable, if you require urgent care, or if self-care followed by a physician office visit is best.
Remember that this is not a call for authorization to seek emergency care. No authorization or referral is required by any Cigna HealthCare medical plan for emergency care. If you believe life or limb are at risk, don't delay. Go directly to the nearest emergency facility or notify your local emergency services immediately. The general public is under the false impression that managed care companies do not provide coverage for new treatments, drugs, or devices — often called experimental treatment — because they are expensive and unproven.
This issue has received a great deal of media attention in relation to coverage for autologous bone marrow transplants ABMT for the treatment of breast cancer as well as coverage for clinical trials. We evaluate requests for coverage for new treatments on a case-by-case basis. The Cigna HealthCare coverage review process uses internal and external sources including its Medical Technology Assessment Council, peer-reviewed medical literature, and independent medical experts to assist its medical directors in reaching coverage determinations.
A consulting ethicist to advise Cigna HealthCare medical management on the ethics of health care decision making. With the ethicist's help, we have developed a decision making tool that makes explicit the ethical dimensions of issues that frequently arise in managed care.
The Cigna HealthCare Medical Ethics Council is a standing committee established to ensure that ethical decision making is an integral part of each health plan's operations. Our Medical Ethics Council includes representation from various departments within the company.
Independent Review. The Cigna HealthCare Expert Review Program assists our medical directors in determining coverage for medically complex cases. The program provides extensive and objective assessments through a network of credentialed, independent medical experts in all domains of medical care. The medical experts may be local medical experts or from nationally recognized academic medical centers.
They render opinions that address the issue of whether the requested technology will specifically benefit the member in question and whether this technology offers advantages over currently proven treatment modalities.
Medical Technology Assessment. The Cigna HealthCare Medical Technology Assessment process evaluates emerging and evolving technologies to help ensure that our members have access to effective treatments. The Medical Technology Assessment Council, composed of national and field medical directors, an ethicist, an attorney and nursing professionals, meets monthly to evaluate independent reports on medical technologies.
The council also reviews reports produced by the Technology Assessment Unit research staff at the request of field medical directors. The actions of the council produce coverage statements that are communicated to all Cigna HealthCare medical directors. The Medical Technology Assessment process is a central source of scientific, objective, and consistent support for the administration of benefits. We oppose legislative mandates that would require coverage for particular treatments or drugs.
Medical science is not static, new treatments are constantly being discovered, and changes are being made to existing treatments on a regular basis. Government should not be involved in deciding what is the best medical treatment for a particular health condition.
Providers unhappy with the changes managed care has made in the way they are paid have raised the issue. They assert that managed care payment arrangements, particularly capitation, reward physicians for providing less care. Managed care is changing the way that physicians are paid. In many cases they no longer receive a fee for every individual service, procedure or treatment they perform. This type of reimbursement encourages overtreatment which, in addition to being expensive, can be dangerous.
There is a misperception that managed care offers physicians financial incentives to cut costs and corners when treating patients. We believe that physicians should direct their efforts toward providing quality health care to Cigna HealthCare participants and that cost reductions can be achieved without affecting quality, simply by eliminating care that is unnecessary or of no proven value. We oppose the use of financial incentives that encourage physicians to withhold necessary care.
We do not offer physicians incentives to deny care. Up to the maximum amount cover per beneficiary per period of cover. International Medical insurance is our essential core policies cover for inpatient, daypatient and accommodation costs - including cancer care, mental health care and other treatments. We provide you three level options of this essential core cover to choose from, Silver Health, Gold Health and Platinum Health.
For additional peace of mind, all of our plans include emergency short-term medical coverage when you are visiting a location outside of your selected area of coverage. Hospital charges for inpatient and daypatient treatment and recovery room, including:. Complications arising from maternity and childbirth - Treatment for life threatening maternity conditions. The following modules detail the optional benefits available to add to your core cover - International Medical Insurance. You can add as many optional benefits as you wish to build a plan that suits your needs.
International Outpatient covers you more comprehensively for outpatient care and medical emergencies that may arise where a hospital admission as a daypatient or inpatient is not required. As well as this, consultations with specialists and medical practitioners, prescribed outpatient drugs and dressings, physiotherapy, osteopathy, chiropractic and much more.
Through this service you will receive following benefits:. International Medical Evacuation provides coverage for reasonable transportation costs to the nearest center of medical excellence in the event that the treatment is not available locally in an emergency.
This option also includes repatriation coverage, allowing the beneficiary to return to their country of habitual residence or country of nationality to be treated in a familiar location. It also includes compassionate visits for a parent, spouse, partner, sibling or child to visit a beneficiary after an accident or sudden illness and the beneficiary has not been evacuated or repatriated.
International Health and Wellbeing covers the beneficiary for screenings, tests and examinations, helping the beneficiary to take control and manage their health the way they want. During each period of cover we will pay for the following tests to be carried out by a medical practitioner. It also covers a wide range of preventative, routine and major dental treatments. Prescription sunglasses; when all are prescribed by an optometrist or ophthalmologist.
International Mother and Baby Care provides cover for the expectant mother during and after pregnancy; including pre and post natal tests and examinations, routine maternity, as well as routine and premature newborn care, ensuring both mother and baby remain healthy.
Benefits under this service include visa application assistance, travel arrangements for flight and hotel bookings when travelling overseas, and ground transportation from the airport to the hospital and return. If you are a Platinum Health customer, you and all beneficiaries will have access to our Travel Concierge Service, which is provided by our chosen third party provider. Covering the costs of arranging and booking a car to transport any beneficiary to a hospital, outpatient clinic or hotel, including the return trip back to the airport.
Where possible we will arrange to pay your hospital, clinic or doctor directly. For Spanish domestic members please find further details on how to claim here. Online Customer Area. We aim to reimburse you within five working days of receiving your fully completed paperwork, and can pay you in the currency of your choice you can choose to be reimbursed in more than currencies.
When you create your tailored plan, you have the option of adding deductibles. If a deductible is chosen, you would only have to pay this once during any period of cover irrespective of the number of claims.
Cost share is the percentage of every claim you will pay. Out of pocket maximum is the maximum amount you would have to pay in cost share per policy year. For example :. If you've sought advice or experienced symptoms before the start date of your plan - whether you have been diagnosed or not - we may decide to add special exclusions to your plan. So it's important that you complete the medical questionnaire as accurately as possible when applying. Our International Medical Insurance provides cover for core benefits, such as emergency dental cover in the event of an accident that requires you to have treatment in a hospital.
If you want more cover, choose our International Vision and Dental option and enjoy access to a wide variety of preventative, routine, major and orthodontic treatments. Yes you are. Inpatient treatment is included as standard within our core International Medical Insurance. It covers you for treatment received as an inpatient when staying overnight in hospital, or when receiving treatment at hospital as a day case. International Medical Insurance covers you for selected outpatient costs such as treatment room fees, surgeon and anaesthetic costs, advanced imaging, cancer and mental health care.
However, the International Outpatient module covers you more comprehensively for outpatient care and medical emergencies that may arise where a hospital admission as a daypatient or inpatient is not required. As well as this, consultations with specialists and medical practitioners, prescribed outpatient drugs and dressings, pre-natal and post-natal outpatient care, physiotherapy, osteopathy, chiropractic and much more.
No it doesn't. Your Cigna ID card is purely a means of identifying you and has no payment capabilities. When you need treatment, call out Customer Care Team. We will arrange to pay your hospital, clinic or doctor directly wherever possible. If you have any questions regarding your payment, our Customer Care Team will be happy to help.
The below provides various ways to reach our team. For Spanish domestic members please view customer contact details here.
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