POS Plans Offers Members Flexibility
The member is feeling pains in her lower legs and chooses to make an appointment with an orthopedic specialist who is not in the CIGNA HealthCare network. The specialist orders lab and X-ray services. Because the specialist is outside the CIGNA HealthCare network, the member is covered, but at a lower level, which means her out-of-pocket costs may be higher. In addition, she is responsible for all authorizations and may have to file her own claim forms for reimbursement.
Cost Example
| Office visit/exam fee |
$125 |
|
| Lab fee |
$50 |
|
| X-ray fee |
$150/$325 |
|
| If member hasn't met the $500 deductible |
| The plan pays |
$0 |
|
| You pay |
$325 |
|
| If member has met the $500 deductible |
|
The plan pays 70% coinsurance |
$227.50 |
|
| You pay 30% coinsurance |
$97.50 |
|
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FAQ
Do I have to choose a PCP?
Yes. Your PCP will give you and your dependents a valuable resource and a personal health advocate. You can choose a PCP from our broad network of participating general and family practice physicians, internists and pediatricians.
Can I change my PCP?
Yes. You and your covered dependents can change you PCP for any reason. Simply select another participating PCP from the CIGNA HealthCare Provider Directory.
Can I see a doctor who does not participate in the CIGNA HealthCare network?
You have the option to visit any doctor; however, when you receive care from a doctor or facility that is not in the CIGNA HealthCare network, your out-of-pocket costs will be higher. You may be required to pay for your care at the time of service and file a claim for reimbursement.
What if my doctor is not on your list?
That means your doctor does not participate in the CIGNA HealthCare network. To receive your maximum benefit, you should select a PCP from CIGNA HealthCare Provider Directory. Participating providers must meet standards to become a part of the network. You can continue seeing your current doctor, even if he or she is not a participating provider. However, in that case, you will pay higher out-of-pocket costs, and your care will be covered at the out-of-network benefits level.
What if my doctor is on the list, but his/her office is shown as "accepting current patients only"? Can I still choose my doctor?
If you are an existing patient of a participating doctor, you may select him or as your PCP.
What if I am in the middle of treatment and my doctor is not in the network?
You should still select a PCP who can review your medical history and work with you to complete your treatment. You also have the option to receive care from your doctor using your out-of-network benefits. You may also be eligible for Transition of Care benefits.
Do I need a referral to see a specialist?
Your PCP must provide you with a referral to see a participating specialist in order for your care to be covered at the in-network benefits level. You can see a participating OB/GYN for covered services without a referral from your PCP. Of course, you also can see a non-participating specialist without a referral, but you will be responsible for the higher out-of-pocket costs and all authorizations.
What if I see a specialist regularly for ongoing treatment? Do I need a referral for each visit?
When you see a participating specialist, you're authorized to receive only the specific services approved by the referral — and those services may or may not include regular visits.
Am I covered for emergency care?
Emergencies are covered 24 hours a day, seven days a week, no matter where you are. So, whenever there is an emergency, seek medical help immediately. Then you will need to contact your PCP as soon as possible for further assistance and follow-up care, including necessary authorizations for care or hospitalization, if necessary. An emergency is an accident or sudden illness that a person with average knowledge of medical science believes needs to be treated right away or it could result in serious medical complications or permanent disability.
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