Our friends at CIGNA have developed a few interesting nuances over the past year. Most of these new issues create denied claims and can leave you and the patient scrambling for a resolution.
Self-funded riders. We have seen a number of patients that have a self-funded CIGNA plan. These plans contain a rider that disallows any phlebology services. Unfortunately, if you (or the patient!) call and ask about the patient’s benefits you will be assured there is no problem. If you then obtain a predetermination review on the services, you will be informed that there is no phlebology coverage. This places you and your practice in a bit of jam as the patient is being told one thing and you now know you will not be paid.
For any CIGNA patients, we now strongly recommend obtaining a predetermination prior to providing treatment. While not required, it is very difficult to determine who has a phlebology rider without this step. You can also have the patient bring this information back to their Human Resources (HR) department at their employer. Quite frequently the HR manager has no idea there is a limit on this benefit. Occasionally the HR manager will override their own plan provisions and agree to have phlebology services covered.
CIGNA is now limiting the length of sclerotherapy that can be performed. You may need to provide new proof (e.g. a new diagnostic ultrasound showing open segments) and obtain a new authorization. It is now critical to know when the authorization will expire and what services were originally approved.
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