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Important Information About In-Network Labs

On 3/1/2013, CIGNA is implementing a change to its claim administrative policy for non-par lab and pathology services received in an office or independent lab.   This is a global change that will be taking place company wide. 

 

This change would impact the following groups:   (Fully Insured Groups Only since this has been in place already for our Self Funded Groups)

 

What is changing?

Whether a customer chooses, or a participating healthcare professional refers a customer to a non-participating lab for tests, CIGNA will reimburse covered services at the client's out of network benefit level under their plan.

For example, claims will be reimbursed at the customer's out of network benefit level and balance billing will be the customer's responsibility under the following scenarios:

  1. If a customer goes to a non-participating lab for testing
  2. If a participating healthcare provider refers them to a non-participating lab for testing,  or
  3. If a participating healthcare provider draws a test sample in the office and then sends the sample to a non participating lab or non participating healthcare professional for testing

What is NOT changing?

Emergencies, contracted hospital stays, federal/state mandates, and network adequacy will continue to be enhanced to in network benefit levels.

 

How are we communicating this upcoming process to our Clients and Healthcare Providers?

There will be a customer communication for this change.  A banner with this information has already been displayed on mycignna.com.  A customer service message has been running since January 1 2013 and will continue to run for 6 months.   A customer flyer will be mailed to customers who have used or have a covered dependent that used non-par labs in the past year.   Lastly, our customer service unit will proactively educate customers about finding/using in network labs when responding to eligibility and benefit questions.


All participating healthcare providers will receive reminders.  We have also sent letters to those participating providers who have higher referral rates to non participating labs. 

 

The attached letter details one simple way to achieve that goal: by making sure employees use in-network labs when their doctors order certain medical tests. I've also attached a sample flyer that our clients can send to their employees to help them understand the advantages of using in-network labs and how to readily find them.Im

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