Before joining the Cigna network of contracted doctors, health care professionals must meet CIgna standards through a process called credentialing. We regularly review doctors' credentials to ensure they continue to meet these standards.
Any doctor not already under contract with Cigna who is able to meet the terms and conditions for participation may apply to join the network.
Even when a doctor is listed in the directory, it doesn't guarantee that the services provided by that doctor are covered under your specific medical plan. Check your plan documents, which describe your particular plan coverage, or call Cigna Customer Service using the number listed on the back of your ID card for information about the services covered under your plan.
If you'd like a paper copy of the directory or help locating a doctor please call Cigna Customer Service at the number listed on the back of your ID card. Help is available to locate a doctor or get a list of doctors. These doctors are qualified to deliver the type of care or covered services you need and are currently taking new patients. If you need help making appointments, call Customer Service.
The best way to find in-network doctors while searching the directory is to log in to your myCigna account, so the search is done with your plan settings.
On myCigna you can also view information on preventive care and other health topics, and learn more about your plan's coverage and your health and wellness programs.
You can see details of your coverage and the types of services covered simply by logging in to your myCigna account. Your coverage details show whether you have prescription drug coverage, coverage for mental health and substance abuse, and/or vision care coverage as a part of your health plan.
Read your Summary of Benefits and other plan documents. If there are any differences between these and what you see on myCigna, your Summary of Benefits is correct.
If you are eligible for the Network Savings Program (NSP), you will see either the Multiplan or Viant network logo printed on your ID card.
NSP is an out-of-network discount program for doctors not in Cigna's network. Your best option for helping to keep your costs low is always to try and use in-network doctors. NSP doctors listed in the directory may offer discounts if you use their services, but these are not guaranteed even if you are eligible for this program. Cigna does not review or credential NSP (out-of-network) doctors for cost and quality and you could pay significantly more for doctors who are out-of-network (NSP) than if you used in-network doctors.
PCP stands for Primary Care Physician. Your PCP will be your source for basic care, advice and direction. Your PCP will also coordinate your total care - from preventive checkups and routine medical care to specialized care and hospitalizations.
Your PCP could be any of the following: family doctor, general practice doctor, internist or internal medicine doctor, OB/GYN or pediatrician; also nurse practitioner (depending on your state's regulations), naturopathic doctor (Vermont) or physician assistant (Massachusetts).
Not necessarily. It depends on the type of plan you have. Some plans require you to choose a PCP; some don't:
No. Each member of your family can choose his or her own PCP or personal doctor.
Depending on your plan you may or may not be required to choose a Primary Care Physician (PCP). Even if you don't have to choose a PCP, there are advantages to having a personal doctor who coordinates your care. Your PCP will:
It depends on your plan coverage. You should refer to your plan documents to learn whether your plan requires you to have a referral before seeing a specialist.
You do not need a referral to see your OB/GYN for an annual preventive care exam, often called a Well Woman exam. Also, if your OB/GYN identifies a medical condition during a Well Woman exam, your OB/GYN can continue to treat you for that condition.
Yes, you can change your PCP at any time by calling the toll-free Customer Service number on your ID card or by logging into myCigna.
If we receive your PCP change request by the 25th of the month, your PCP change will begin on the first day of the following month.
NOTE: If you are receiving specialty care and decide to change your PCP, your new PCP will need to provide a referral to your specialist for any services received after the start date of your PCP change.
When you need medical care, it's important that your doctor, hospital or other health professional sees you as soon as possible. There are standards, required by law, to make sure your appointment happens in a timely manner.
The following legal standards set the number of days or weeks you can wait for an appointment based on your medical needs:
Emergencies are medical problems that are life-threatening. Examples are heart attacks or serious injuries.
Urgent: Within 24 - 48 hours.
Urgent medical needs are not emergencies, but they do require prompt medical attention. They include illnesses with symptoms, such as the flu, infections and broken bones that can be set in a medical office instead of in a hospital.
Regular or Routine Care: 7 - 14 days.
These are medical needs that can wait. Examples are routine blood work or a blood pressure check after your doctor prescribes a new medication.
Preventive Screenings and Physicals: Within 30 days.
These include your annual physical and preventive screenings. Examples are mammograms and cervical or prostate cancer screens.
Obstetric Prenatal Care: The standard depends on the stage of your pregnancy and your medical situation:
To ensure all customers receive timely care, Cigna conducts an annual survey of doctors, hospitals and other health care professionals to make sure they are complying with these standards.
Doctors, hospitals and other health care professionals are required by law to conform to standards for scheduling medical appointments. These standards are based on your medical needs.
If you feel that your doctor, hospital or other health professional is not scheduling appointments in a timely way or is not complying with the legal standards, you can notify Cigna by:
Precertification is a review process where Cigna nurses, pharmacists and/or doctors work with your doctor to decide:
Your plan may require precertification for hospital admissions and some outpatient services. When precertification is required, a Cigna nurse reviews the request using nationally recognized guidelines. These guidelines help the nurse decide what services are covered based on your plan coverage. The guidelines have been developed with involvement from actively practicing health care professionals and are consistent with sound clinical principles and processes. If there are no guidelines available for a service, the nurse uses clinical resource tools based on clinical evidence instead.
If 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 get more information. The Cigna doctor makes the decision based on the information received and your plan coverage. You and your doctor will be notified in writing if a request for a precertification cannot be approved.
The review process can happen at three different times:
If your situation requires that a decision is made right away (expedited review), then Cigna will perform a quick review. This decision will be completed within one business day.
Medical doctors evaluate coverage denials when clinical factors are the reason for the denial. A denial letter will explain the reason for the decision. The letter will also provide details on how to submit additional information and/or how to proceed through the formal Appeals Process, if you disagree with the coverage decision.
You can search for places by type ("cancer treatment center") or proper name using the search boxes or you can browse through directory lists using the "Find a Person" and "Find a Place" selections. To find a place that provides cancer treatment services, for example, you can:
You can search for people by specialty ("physical therapy") or proper name using the search boxes or you can browse the directory using the "Find a Person" selections. To find a Physical Therapist, or another health care professional that is not a doctor, dentist, eye doctor, or mental health professional you can:
You can find information on Ophthalmologists and Optometrists in the health care professionals directory. For other eye care services (lenses, frames, routine eye exams, etc.) you will need to search the Cigna Vision Directory. There are two ways to access vision services:
You can get consistent, relevant, and timely information about your plan any time that's convenient for you by:
For more information, please call Cigna Customer Service at the toll-free number on your Cigna ID card.
Custom Network Directories differ, so there is no simple answer. Your employer may have very specific requirements for using one or the other. If you have questions about which directory to use or how to use your Custom Network Directory, contact your employer's health plan administrator before seeking services.
When you do a search, your search results will be sorted by quality first, if available. Otherwise, they may be sorted according to cost estimates and distance. A sorting drop-down menu located at the top of your results list will indicate how your results are initially sorted. You can then use the drop-down to re-sort the results based on the sorting options available.
Cigna Care Designation (CCD) gives a special status to medical specialists who meet certain quality and efficiency guidelines and who practice in one of these specialties:
Yes, but you may pay more. If your plan includes Cigna Care Designation coverage (check to see if "Cigna Care Network" is printed on your ID card), and you need care in one of the network specialties (see "What is the Cigna Care Designation?" FAQ for the list), here's what will happen when you receive covered services:
Participating specialists are evaluated every two years for the Cigna Care Designation.
Cigna Care Designation is awarded to individual participating doctors in one of the following reviewed specialties based on the following criteria:
Specialists who perform in approximately the top 33 percent in the market for these measures receive the CIGNA Care Designation. Designation is also awarded to participating doctors' groups/practice in one of the reviewed specialties that has at least one MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) in the group and:
Cigna identifies hospitals as Centers of Excellence (COE) when they achieve the highest scores for cost efficiency (cost value) and effectiveness in treating certain procedures/conditions (patient outcomes, or results of care), based on publicly available patient data. This is a partial evaluation of hospitals based on the patient outcomes (results of care) and cost-efficiency (cost value) information for the selected surgical procedures and medical conditions.
This is provided as an informational tool only and you should not use it as the sole source for making a health or medical decision. Talk to your personal doctor when you are choosing a hospital. Even though a hospital is not rated as a COE, it may still provide quality medical care.
Not all hospitals are rated Cigna Centers of Excellence (COE). Many factors affect Cigna's ability to rate a hospital as a Center of Excellence, including but not limited to:
Any of the above can affect both patient outcomes and cost effectiveness measurements and Cigna's ability to make a quality rating.
Even though your hospital is not identified as a Center of Excellence it may still provide you and your family with quality medical care and services. The Cigna hospital ratings are provided for informational purposes only and should not be used as the sole source for making a health or medical decision. Always consult with your primary doctor when making decisions that affect your medical care, including choice of hospital.
Yes, your plan does pay a significant portion of your costs, depending on your coverage. For example:
Cost estimates may help inform you about the differences in health care costs, which is why we recommend you to log in to myCigna to see your personalized cost estimates. The more well informed you are, the better prepared you are to make educated choices when it comes to choosing a doctor or services. These are informational tools only and you should not use them as the sole source for making a health or medical decision.
Costs can vary based on a number of factors, including:
Also some hospitals consistently care for more seriously ill patients than do others, which can also affect hospital cost information.
You should be aware that the cost ratings information you may see in the search results for a medical procedure may be affected by a variety of factors. These can include:
Please note that just because a procedure has a better cost rating, it doesn't always mean that having the procedure at that hospital will cost you less.
Information about doctors and other health care professionals is updated at least once every 15 days. Information may have changed since the last update.
If you see incorrect information listed for your doctor you can call Customer Service at the toll-free number to report it or to provide correct information: 1.800.244.6224. Note: If you call to correct information, it could take up to 15 days before it's changed in the system.