Cigna HealthCare is committed to achieving and maintaining quality in our business with respect to:
- Accreditation Recognition
- Health Management Resources
- Customer Effectiveness of Care and Satisfaction Outcomes
- Patient Safety
- Provider Recognition
- Provider Credentialing and Recredentialing
- Medical Record Reviews
- Medical Technology
- Medical Ethics
- Advantages of Being a Cigna HealthCare Participating Provider
- Practitioner Rights and Responsibilities
- Cigna Member Rights and Responsibilities for Customers
We are dedicated to meeting external industry standards for quality and patient safety. That's why we have respected independent organizations evaluating our performance and quality. We report these results publicly so you can see to what extent we're meeting external quality standards.
National Committee for Quality Assurance (NCQA)
Cigna has been committed to obtaining third-party external accreditation of its quality program through NCQA accreditation review process since 1993. CIGNA’s national Quality Program and Quality Committee Structure afforded CIGNA the ability to pursue NCQA accreditation for one national, multi-product survey in 2011. The evaluation included 95 Cigna markets. In December 2011, the National Committee for Quality Assurance (NCQA) accredited all 95 of the health plans that CIGNA submitted for review based on one national survey for all health plan types in all markets. Plans in 94 percent of markets earned a “Commendable” or “Excellent” accreditation. Sixty-three percent of markets were awarded “Accredited” status.
Cigna was the first national Health Plan to receive NCQA Physician and Hospital Quality (PHQ) Certification of its program and its processes. In 2011, Cigna remained the only National Health Plan to achieve this certification for both physician and hospital quality. The Physician and Hospital Quality Certification validates Cigna's commitment to ensuring valid, fair, and accurate measurement to provide reliable information to individuals, physicians, and hospitals.
URAC (formerly the Utilization Review Accreditation Commission)
Our utilization management and case management programs have been awarded full accreditation status by URAC. Our utilization management and case management policies are based on standards set by URAC.
Joint Commission on Accreditation of Health Care Organizations (JCAHO)
Participating hospitals are accredited by JCAHO, or must undergo onsite reviews by the state, Medicare or Cigna, based on NCQA standards.
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Health Management Resources
Our customer health and wellness programs can help people get healthy and stay healthy. We offer 24-hour health information, support for healthy moms and babies, transplant care management, pharmacy outcome improvement and chronic condition management.Through these programs, a variety of reminders are sent to customers and/or their physicians to encourage important health screenings, exams and immunizations.
Prevention and Screening are key components of helping customers stay healthy and lead to quality, cost effective care. Reminding customers and/or physicians when services are due or missed using claim data is critical to our success. Examples of programs that support this goal are:
- Well Informed Program - Reminders are sent to customers and their physicians when a potential gap in care has been identified in receiving important evidence-based medicine services. The program encourages customers to collaborate with their physicians to take appropriate steps in closing the gap in care identified which could include missed medications, health screenings or exams. For example, women age 40 - 69 who have missed a mammogram in the last 24 months are reminded about the need for this service and their physicians are notified of the missed service.
- Colorectal Cancer Screening Program - An educational brochure is sent to customers ages 50 – 64 who are identified as not having a recommended colorectal cancer screening test. The brochure provides information on the importance of screening in the early detection and prevention of colorectal cancer. It also offers customers the option to request a fecal immunochemical test kit. Customers can request the collection kit by visiting the program web-site or calling a toll free number.
- Immunization Reminder Program - Reminder mailing with follow-up phone message to the parents of children who may have missed a recommended vaccine by the time of the child’s 8th month and 17th month well visits. The postcard reminder also encourages parents to follow-up with their child’s doctor.
- Preventive Care Benefit Guidelines - Our Preventive Care Benefit Guidelines are based on U.S. Preventive Health Services Task Force guidelines and other nationally recognized organizations. The guidelines are reviewed and endorsed by Cigna's Clinical Advisory Committee whose members include Cigna participating health care professionals.
Chronic Condition Management
Cigna's Chronic Condition Management Programs provide assistance based upon medical, behavioral and lifestyle factors associated with chronic conditions. Traditionally the industry has focused on the individual's heath needs one at a time, or correlated care across different programs. Cigna now has the ability to look at individuals holistically, weaving together services and support to meet each person's needs through one program.
Our chronic condition management programs include a number of services designed to help customers better understand and manage their condition. We work with you to create a plan that helps customers successfully reach their health goals. We do this through coaching and self-guided support tools. Customers have access to the Personal Health Team who help customers:
- Recognize worsening symptoms
- Establish questions for customers to ask their doctor.
- Understand the importance of following doctor’s orders.
- Develop health habits related to nutrition, sleep, exercise, weight, tobacco and stress.
- Make educated decisions about treatment options.
The programs encourage customers to follow their doctor’s direction and treatment plan.
On-line self service tools include tools to help customers understand their condition and make more informed treatment decisions.
Fast and Accurate Identification
Cigna uses a broad range of information such as medical and pharmacy claims, and Health Assessment results to identify chronic conditions. We perform this review regularly to identify health status changes. When customers are identified with a chronic condition, they receive information from us on benefits of the program and we confirm that they want to be involved. We send carefully selected, evidence based program materials to you and your patient. You may refer to the program by calling the Customer Service number listed on your patient's Cigna ID card and customers can also call us to self-enroll.
Customer Effectiveness of Care and Satisfaction Outcomes
As a provider in the Cigna network, your commitment to quality care greatly contributes to our members care and satisfaction outcomes.
*HEDIS® – Measurements of Clinical Success
Cigna uses HEDIS clinical metrics to measure the results of many clinical interventions. Annually, we measure and report clinical effectiveness results for our medical plans (HMO/POS and PPO/OAP), and submit these results to NCQA to be included in developing national benchmark data. Our strong results demonstrate our success in supporting quality care for our customers.
With your help over the last several years, we have seen a large jump in the number of customers having important preventive care screenings and doctor follow-up.
Clinical initiatives are actively pursued in order to promote improved health, well-being and sense of security. These initiatives include asthma, cholesterol management following a cardiac event, breast cancer screening and childhood immunizations, to name just a few. We promote preventive care through telephone outreach and mailings to people who are identified through claims data as potentially not having had recommended screenings, vaccines or physician follow-up. We partner community organizations and employers to offer incentives and education.
* HEDIS (Healthcare Effectiveness Data and Information Set) is a registered trademark of the National Committee for Quality Assurance (NCQA).
*CAHPS® - Customer Satisfaction Measurements of Success
Cigna is committed to promoting quality service. We participate in the National Committee for Quality Assurance (NCQA) Member Satisfaction Survey to obtain your feedback on how we are doing. This annual survey measures performance in key areas of care and service delivery. Cigna attempts to maintain and improve results each year by taking action on opportunities identified from customer feedback. For example, we made information easier to obtain, more helpful and understandable. We did this by launching a new simpler-to-navigate website. The Cigna ‘Cost of Care Estimator Tool’ was created for you to use with your patients to identify treatment choices for care that better fits their budget. Our personalized website offers teaching tools to increase understanding of various health topics. We also updated the letters and postcards we mail to customers.
Customers told us they want increased access to care and service. We improved access to Customer Service by opening call centers 24 hours a day, 7 days a week. Customers can now use web-enabled mobile phones to get immediate answers in both English and Spanish that are customized to their health plan benefits through Cigna Mobile on myCigna.com. We also actively work to increase our network of qualified health care professionals and convenience care clinics to make sure customers can get needed care quickly.
Cigna delivers affordable care, improves outcomes and provides superior service. We offer programs focused on driving behavior change and medication adherence to improve your patients’ total health. We make medications more affordable and apply an integrated approach to care. These programs support you and your patients who have both Cigna pharmacy and medical benefits. If you have patients who could benefit from these programs, we may send you letters and/or reports with information specific to your patient and information on how these programs can help. Our pharmacy clinical programs include:
- Well Informed Program (Gaps in Care) - The program uses the most up-to-date evidence-based medical care standards to identify potential gaps for your patients. The program addresses disease prevention and focuses on over 30 chronic illnesses and acute conditions including diabetes, COPD, hypertension, depression, high cholesterol and more.
- Complex Psychiatric Case Management - The program is designed to provide physicians and psychiatrists with an integrated solution for their patients taking multiple psychotropic drugs. The program targets individuals on a complex psychotropic medication regime with potential for treatment optimization and care coordination.
- Narcotics Therapy Management - The program uses comprehensive medical information to form a complete view of individual's medical conditions and prescription drug use. Cigna creates detailed patient profiles to identify who exhibits use patterns that may be indicative of narcotic fraud and misuse and inform their physicians via provider reports.
- CoachRx - The program takes a proactive approach and reaches out to individuals before they have trouble adhering to their medication regime. Through pharmacy coaches and interactive tools, Cigna can help them understand what is getting in the way and then work with them to overcome challenges, change behaviors and ultimately improve their health.
- Cigna Specialty Pharmacy Management - Specialty medications are made via biotechnology processes and are used to treat the cause of the disease rather than the symptom. These diseases affect less than 4% of the population but are chronic in nature and rarely cured. Cigna's approach to specialty pharmacy is to provide affordable care, maximize outcomes and provide holistic service.
- TheraCare supports - Cigna customers who use specialty medications to treat certain chronic conditions like multiple sclerosis, hepatitis C and rheumatoid arthritis. It provides added support to your patients and helps them to better understand their condition, medications, side effects and the importance of taking their medication as prescribed. As you know, medication adherence can lower the risk of side effects and improve the effectiveness of the medication. We have found in many cases, that patients’ health and quality of life are improved when they comply with their treatment plan.
- Cigna Home Delivery Pharmacy - provides access while improving health. We offer 24/7 access to customer service and pharmacists to help answer any questions, convenient home (or preferred location) delivery, helpful coaching and reminder services and access to supplies, educational materials and more. It has been shown that customers who use Cigna Home Delivery Pharmacy are 20% more adherent with their medications than customers who use retail alone. Please visit our Cigna Home Delivery Pharmacy page for more information.
We promote the health and safety of our customers through quality tools and measures.
The Leapfrog Group
The Leapfrog Group is a not-for-profit organization committed to triggering giant leaps forward in the safety, quality and affordability of health care by:
- Supporting informed healthcare decisions by those who use and pay for health care; and,
- Promoting high-value health care through incentives and rewards.
Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care. To learn more about the Leapfrog Group, please visit http://www.leapfroggroup.org*
Cigna is a Leapfrog Group Star Partner. As a Partner, Cigna works collaboratively with Leapfrog and its Board of Directors to support their mission of promoting patient safety initiatives in the following ways:
- Participation in the Leapfrog Group’s Health Plan Users Group (HPUG)
- Created in 2004, HPUG brings together Leapfrog members and Health Plans to collaborate and develop goals and evaluation criteria metrics.
- Cigna completes and submits a performance dashboard to the HPUG annually and shares this information with employer clients
- Collaboration with regional employers and industry partners to help coordinate local efforts to advance Leapfrog’s mission
- Support of Leapfrog critical initiatives, such as:
- Leapfrog Hospital Survey
- Cigna performs outreach to contracted hospitals to encourage participation in the Survey, via direct mail and Network News
- Cigna incorporates Leapfrog measures into the Hospital Quality Index for Centers of Excellence ratings, and makes publicly available information related to those network hospitals who participate in survey
- Early Elective Deliveries
- Cigna is an active member of this multi-stakeholder group, led by Leapfrog, which aims to reduce early elective deliveries. We also have an internal workgroup (comprised of Quality/Transparency, Medical Directors, Product, and Marketing) which is charged with planning and executing on educating customers, network providers and hospitals.
- In 2011, Cigna outreached to more than 2200 pregnant women to spread the message that babies and mothers stay healthier when elective deliveries are delayed until after the 39th week of pregnancy
- In 2012, we are expanding our outreach to include network providers and hospitals, as well as customer education.
- Participation and sponsorship of the Annual Leapfrog meetings
- Participation in the Leapfrog Health Plan Lilipad Group quarterly meetings
- Leapfrog Hospital Survey
We encourage quality through a variety of recognition programs designed to reward excellence, help change and improve practice patterns, help improve care, and provide customers with tools to make more informed decisions.
Our Provider Excellence Recognition Directory includes participating physicians who have achieved quality-related recognition from the National Committee for Quality Assurance (NCQA) for Diabetes, Heart/Stroke Care, Back Pain, Physician Practice Connections and Physician Practice Connections – Patient Centered Medical Home.
Many physicians applying for NCQA recognition reported their practice patterns improved and/or changed to ensure care was delivered consistently with established treatment guidelines.
Also included are participating hospitals that meet one or more of The Leapfrog Group patient safety standards.
Hospital Centers of Excellence
Our program supports the growing consumer demand for information on hospital outcomes and efficiency for specific diagnoses and procedures. Through this program, participating hospitals have both a patient outcomes and cost efficiency score for several procedures/conditions. To learn more about Cigna's Centers of Excellence program, follow the attached link for Cigna Centers of Excellence Whitepaper.
Physician Quality and Cost Efficiency Profile
Customers have online access to quality and cost efficiency displays for 19 physician specialties and 3 primary care specialties. Employers are asking us to help their employees - our customers- make more informed health care choices. To continue to support the industry's movement toward consumerism, we have created programs that align with the Consumer Purchaser Disclosure project, to provide health care quality and price information for consumers.
Cigna was the first national healthplan to receive NCQA Physician and Hospital Quality (PHQ) Certification of our quality and cost display methodology in 2009 and have maintained the certification since that time.
Profiles for participating physicians in 22 specialties are available in most service areas in the form of quality icons and star (*) designations for cost efficiency. Quality displays are available to consumers via Cigna's public provider directory and secure directory for Cigna customers. Cost efficiency displays are viewable only by customers via the online provider directory on our secure customer website.
Quality icons are determined based on:
- National Committee for Quality Assurance (NCQA) recognition for diabetes care, cardiac and stroke care, low back pain or patient centered medical home –physician practice connections.
- Performance on select evidence-based quality measures derived from measures endorsed by organizations like the Ambulatory Care Quality Alliance (AQA), National Quality Forum (NQF) and Health Plan Employer Data and Information Set (HEDIS) as well as others.
- Satisfaction of our board certification criteria.
- For bariatric surgeons performing at a Certified Hospital for Bariatric Surgery satisfaction of our bariatric surgery criteria.
Cost efficiency stars reflect a specialist's cost efficiency relative to peers using the Episode Treatment Groups (ETGs) methodology. This methodology looks at medical costs for an episode of care (inpatient, outpatient, laboratory, radiology, pharmacy, etc.) and includes case-mix adjustment to help account for differences in the severity of patients' illnesses.
The quality and cost efficiency displays represents only a partial assessment of a specialist's quality performance and cost of care. We encourage customers to consider all relevant factors and to speak with their treating physician when selecting a specialist.
Cigna Care Designation
Cigna Care Designation (CCD) is a benefit plan option available for Cigna plans in 77 service areas across the country as of January 1, 2012. Developed in response to our customers' requests for more information about physician quality and cost efficiency, the Cigna Care Designation helps distinguish physicians within our provider network based on their performance under specific quality and cost efficiency measures in 19 areas of specialty care.
Under the Cigna Care Designation benefit plan, a subset of participating physicians in specialties receive the Cigna Care Designation display icon based on specific selection criteria. These specialties include allergy and immunology, gastroenterology, gynecology, orthopedics and surgery and dermatology. Physicians with the designation have a Cigna Tree of Life icon displayed next to their name in the Cigna directory.
Cigna participating providers are considered in-network whether or not they receive the Cigna Care Designation. However, a lower customer co-payment or coinsurance level may apply if the customer chooses a Cigna Care Designation physician. To learn more about Cigna Care Designation follow the attached link for Cigna Care Designations Whitepapers.
Provider Credentialing and Recredentialing
You must meet our standard credentialing criteria to become a provider in a Cigna network. Our credentialing process evaluates practitioner qualifications including certification, training, licensure and criteria related to professional conduct. Recredentialing occurs every three years or sooner if required by law.
Our credentialing criteria include, but are not limited to the following (when applicable):
- Signed application and agreement (see information about CAQH below)
- Verification of unrestricted state medical license with appropriate licensing agency
- Verification of valid, unrestricted DEA certificate
- Verification of full, unrestricted admitting privileges in good standing on the medical staff at a Cigna participating hospital
- Satisfaction of our board certification criteria
- Satisfactory malpractice claims history
- Verification of education and training
- Review of work history
- Verification of adequate malpractice insurance
- Acceptable history relative to all types of disciplinary action by any hospital and health care institution and any licensing, regulatory, or other professional organization with jurisdiction over the applicant
- Proof of appropriate professional licensing (only for practitioners whose professions do not require medical licensure)
Cigna participates in the Council for Affordable Quality Healthcare (CAQH) collaborative. CAQH provides the Universal Credentialing DataSource, a standard application source completed once by the practitioner, helping to eliminate redundant requests for the same information from multiple organizations.
Practitioners can submit an application using the CAQH Universal Credentialing DataSource application at www.caqh.org. Call 1.800.88Cigna to inquire about our need for additional practitioners in your specialty.
Once your application and agreement have been received, we will notify you to correct any erroneous information if credentialing information obtained from other sources varies substantially from what you provided. If you wish to review information submitted to support your application, including information from outside sources, or to check the status of your application, call 1.800.88Cigna (882.4462).
Once your credentialing file is complete and we verify your credentialing information, we'll present it to the health plan credentialing committee. This committee is composed of community physicians for peer review, and the health plan medical director. If you are accepted for participation into our network you will receive a welcome letter within 60 days of the date of the decision, or sooner, if required by state law. If you are not accepted for participation in our network that information will be communicated to you in writing.
Medical Record Reviews
Physicians use medical records to plan patient care and provide information about the patient's medical treatment. As a permanent record, the patient's medical record provides the necessary information to provide good continuity and coordination of care.
As part of our quality improvement program, Cigna conducts Ambulatory Medical Record Review (AMRR) for physicians in our direct contract networks. AMRR evaluates medical records, but does not define standards of care or replace clinical judgment.
- Selection - We select a random sample of medical records from network primary care-type physicians who have more than 30 Cigna customers as patients. This sample includes internal medicine, family practice and pediatric practitioners. The review is conducted by fax. A quality measurement representative will work with you and your office staff to facilitate access to the record samples designated for review.
- Documentation - Medical records should be current, detailed and organized to ensure Cigna customers receive effective, safe and confidential care. Medical records should include:
- Updated, completed problem list or summary of health maintenance exams
- Current prescription medication list or medication note
- Allergies/intolerance to medication
- Adverse reactions to medication
- Past medical history
- Visit exam coincides with chief complaint
- Plan of treatment documented
- Lab and diagnostic studies were reviewed
- Each visit follow-up was noted
- If consultation is requested, report was received
- If a consultant report is present, it was reviewed
- Non-behavioral health screenings for alcohol
- Non-behavioral health screenings for tobacco use
- Each visit examination identifies subjective and objective information
Sample medical record documentation tools are available from our Quality Measurement and Improvement Department.
Other important information
- Confidentiality - Providers must maintain confidentiality of all medical records and treatment information in accordance with state and federal law.
- Goals - Performance goals are established by our Clinical Advisory Committee and serve as the benchmark for quality medical records.
- Consultations - Cigna uses a consultative approach to conducting medical record reviews and offers suggestions and tools for physician practices to assist in increasing the overall performance score.
The following best practices have been identified and are associated with complete medical record documentation:
- The use of an electronic medical record documentation system, that addresses all important aspects of care (i.e., allergies, adverse reactions and instructions for return visit follow up care), improves legibility (with fewer errors and omissions), patient safety and continuity of care.
- The use of a stamp or sticker on the front of the chart specifying patient allergies and adverse reactions improves consistency of allergy documentation.
- The use of a pre-printed or downloadable chronic care management tools for tracking assessments, planning and follow-up needs from medical associations, serves as a quick guide for overall disease management & treatment goals.
- The use of a Problem List/Health Maintenance tool updated regularly with medications, patient and family history improves patient care management & safety.
Continuity and Coordination of Care
To ensure seamless delivery of care to our customers, throughout their course, Cigna is committed to assessing the continuity and coordination of care. If disruptions and delays in treatment can be avoided potentially poor outcomes can be averted. Good continuity and coordination of care must be maintained regardless of the number of medical specialties or medical and behavioral specialties utilized by the patient. According to recent data, approximately one-half of medical records reviewed indicate providers are effectively communicating information and coordinating care. Through communication, planning, and collaboration continuity and coordination that meet the patient’s needs can ultimately be achieved.
The most commonly identified barriers to coordination of care include:
- Lack of recognition for the need to communicate;
- No means for communicating information; and
- Unaware other providers were involved in the care.
To help facilitate communication between providers, Cigna has developed communication tools available to download. These tools may serve as a model for exchanging clinical information throughout the coordination of care:
- Asthma Emergency Department Visit Continuity and Coordination Report
- Diabetic Retinal Exams: Fact Sheet
- Diabetes Flow sheet
- Cardiology Continuity of Care Report
- Ophthalmology/Optometry Continuity and Coordination Report
- Behavioral and Primary Care Physician (PCP) Communication Tools
Behavioral conditions often present in primary care settings. Cigna's behavioral website contains links and resources intended to support Primary Care Physicians in assessing, treating, and/or referring commonly seen behavioral problems.
Our Medical Technology Assessment Committee reviews new, emerging and evolving medical devices and equipment, diagnostic tests, procedures, therapies and behavioral health procedures in an effort to ensure we provide coverage only for services which are medically necessary and proven safe and effective for our customers.
The committee, consisting of physicians analyzes published peer reviewed medical literature, medical professional society positions and guidelines, consensus guidelines and technology assessments as well as evidence summaries from external experts in the field to determine if new or emerging technologies will be approved for coverage.
After a technology receives approval from the appropriate government regulatory agency (if needed), the committee evaluates answers to questions such as:
- Is the technology proven safe and effective?
- Are the studies/clinical trials well conducted with sound study methodology?
- Are health outcomes positive and do these positive outcomes outweigh any harmful effects?
- Is the technology available outside of the investigational/research setting?
As an industry leader, Cigna recognizes the importance of ethics in health care today. We were one of the first managed care companies to examine ethical issues and develop a set of formal ethical principles to frame clinical decision-making in general. We were also one of the first to develop an ethics-based care management decision tool to support our physicians as they make complex medical decisions.
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Advantages of Being a Cigna HealthCare Participating Provider
We share your commitment to providing quality health care to our members.
We're committed to quality and patient safety. Our organization has gone through accreditation by the National Committee for Quality Assurance (NCQA).
- We can help you manage your practice. We provide practice management tools to help streamline your administrative practices.
- We can provide clinical resources. You'll have access to clinical care guidelines to help you decide how to screen for and treat various conditions.
- We support physician-patient communication. We encourage our participating providers to discuss treatments and procedures freely and openly, even if they're not covered by a member's benefit plan.
- We recognize quality providers. We have a special directory of participating providers who have achieved quality-related recognition from the National Committee for Quality Assurance (NCQA) for diabetes or heart/stroke care. It also includes participating hospitals that meet The Leapfrog Group patient safety standards.
- We focus on wellness. We want our customers to get healthy and stay healthy. That's why we offer member health and wellness programs that provide 24-hour health information, support for healthy moms and babies, transplant care management, pharmacy outcome improvement and chronic condition management.
- We communicate with you. We want to be aware of your concerns, and we want you to be aware of what's happening at Cigna. Our Network News newsletters provide important updates on policies and procedures, health-related news and tips, and more. In addition, we post important updates on this site. If you would like to voice a complaint or inquire about an appeal or dispute, please call 1.800.88Cigna (882.4462).
- Participating providers can have a peer-to-peer discussion about any utilization management decision which was not approved or certified. Providers can initiate peer-to-peer discussions by contacting the Cigna Health Services Department at 1.800.88Cigna (882.4462).
Practitioner Rights and Responsibilities
Practitioners’ Rights The following is a statement of your rights to know what to expect when working with our staff.
You Have the Right to:
- Have information about our programs and services, staff qualifications and any contractual relationships.
- Decline to participate in or work with our disease program and services for your patients, if the client’s contract allows.
- Be informed of how we coordinate interventions with treatment plans for individual patients.
- Know how to contact the person responsible for managing and communicating with the practitioner’s patients.
- Be supported by us when interacting with your patients to make decisions about their health care.
- Receive courteous and respectful treatment from our staff.
- Communicate complaints and provide feedback to us.
Cigna Member Rights and Responsibilities for Customers
The following statement of customer rights and responsibilities is given or made available to customers when they enroll and annually through our Commitment to Quality collateral available on the customers secure website. While states may mandate variations, the statement typically reads as follows:
You Have the Right to:
- Receive medical treatment that is available when you need it and is handled in a way that respects your privacy and dignity.
- Get the understandable information you need about your health benefit plan, including information about services that are covered and not covered, and any costs that you will be responsible for paying.
- Obtain information about the qualifications of clinical staff that support Cigna wellness and similar programs.
- Have access to a current list of in-network doctors, hospitals and places you can receive care, and information about a particular doctor’s education, training and practice.
- Select a primary care doctor for yourself and each covered member of your family, and change your primary care doctor for any reason.
- Have your medical information kept confidential by Cigna and your doctor. Cigna honors the confidentiality of customers’ information and adheres to all federal and state regulations regarding confidentiality and the release of personal health information.
- Participate with your health care professional in health decisions, and have your health care professional give you information about your medical condition and your treatment options, regardless of coverage or cost. You have the right to receive this information in terms and language you understand.
- Learn about any care you receive. You should be made aware of any special Cigna programs or services available to assist you, as well as how to enroll, or change programs or services. You should be asked for your consent for all care, unless there is an emergency and your life and health are in serious danger.
- Refuse medical care and disenroll from programs/services offered by Cigna. If you refuse medical care, your health care professional should tell you what might happen. We urge you to discuss your concerns about care with your primary care doctor or other participating health care professional. Your doctor or health care professional will give you advice, but you will have the final decision.
- Be heard. Our complaint-handling process is designed to: hear and act on your complaint or concern about Cigna and/or the quality of care you receive from health care professionals and the various places you receive care in our network; provide a courteous, prompt response; and guide you through our grievance process if you do not agree with our decision.
- Make recommendations regarding our policies that affect your rights and responsibilities.
You Have the Responsibility to:
- Review and understand the information you receive about your health benefit plan. Please call Customer Service when you have questions or concerns.
- Understand how to obtain services and supplies that are covered under your plan.
- Show your ID card before you receive care.
- Schedule a new patient appointment with any in-network primary care doctor; build a comfortable relationship with your doctor; ask questions about things you don’t understand; and follow your doctor’s advice. You should understand that your condition may not improve and may even get worse if you don’t follow your doctor’s advice.
- Understand your health condition and work with your doctor to develop treatment goals that you both agree upon.
- Provide honest, complete information to the health care professionals caring for you.
- Know what medicine you take, and why and how to take it.
- Pay all copays, deductibles and coinsurance for which you are responsible, at the time service is rendered or when they are due.
- Keep scheduled appointments and notify the health care professional’s office ahead of time if you are going to be late or miss an appointment.
- Pay all charges for missed appointments and for services that are not covered by your plan.
- Voice your opinions, concerns or complaints to Cigna Customer Service and/or your health care professional.
- Notify your plan administrator and treating health care professional as soon as possible about any changes in family size, address, phone number or status with your health benefit plan, or Cigna’s programs and services.