by AJ Riviezzo
Cigna is frequently the insurer used to administer self-funded plans. These are plans where all claim payments are made by the employee’s company. Cigna prices their services for these plans and give the employer an idea of costs associated with the various plans or models.
Unfortunately, we are seeing an increase in various self-funded plans wherein all venous services are excluded. These were somewhat common some years back, but they now seem to have come back in a large way. We have reports of authorizations being denied across the country.
As a practice, it is essential to double-check if the patient has venous disease coverage and not just check their eligibility. Yes, the patient is eligible, but no, they don’t have coverage for your services. If services are provided in error, you may not be able to bill the patient. Cigna will state the error was yours and the contract does not allow you to bill the patient. What recourse do you have? Not much of one as the denial is written into the plan. You can have the patient (or their spouse if they are the employee) contact their Human Resources department. Many times the company is surprised that a common procedure has been excluded. As the company is the ultimate payer of the claims, they can, if they wish, override the Cigna enforced exclusion allowing your patient to receive the care they need.