Cigna Member | HMO Referral Issues

[newbie2001]

Hi, Cigna sunsetted all of their PPO's in my area this year so I had to move a client to their HMO plan because of costs and network.

He sees 5 specialists…

With that being said his PCP is trying to submit the referrals and Cigna is coming back saying he is inactive.

I spoke with his Dr's office, broker services, and member services.

No one can seem to figure out what to do.

I love to provide personal service to my clients and this guy in particular needs a lot of hand holding but it sucks up hours of my day. Does anyone else provide service like this or do you tell them good luck call member services?

When I spoke with member services they told me the specialist is out of network which is simply untrue. That the member would have to call in and request the referral??

Then I asked them to 3 way the Dr's office with me to which they called the health systems corporate office and then promptly hung up the phone.

Help is appreciated.

Thanks.

 

[somarco]

specialist is out of network

Out of network for the HMO plan or the PPO plan?

HMO networks are usually a lot smaller (fewer providers) than PPO networks. They are rarely identical.

 

[newbie2001]

Out of network for the HMO plan or the PPO plan?

HMO networks are usually a lot smaller (fewer providers) than PPO networks. They are rarely identical.

Out of network for HMO. PPO's no longer offered.

But the provider is in network is my point.

 

[Special Agent]

Hi, Cigna sunsetted all of their PPO's in my area this year so I had to move a client to their HMO plan because of costs and network.

He sees 5 specialists…

With that being said his PCP is trying to submit the referrals and Cigna is coming back saying he is inactive.

I spoke with his Dr's office, broker services, and member services.

No one can seem to figure out what to do.

I love to provide personal service to my clients and this guy in particular needs a lot of hand holding but it sucks up hours of my day. Does anyone else provide service like this or do you tell them good luck call member services?

When I spoke with member services they told me the specialist is out of network which is simply untrue. That the member would have to call in and request the referral??

Then I asked them to 3 way the Dr's office with me to which they called the health systems corporate office and then promptly hung up the phone.

Help is appreciated.

Thanks.

First confirm they are actually enrolled in cigna.this is easy to do on Jarvis and other agent portals.If they are indeed enrolled in cigna then i bet it is an issue with cigna's online directory not being updated or errors since dropping the ppo's so it is very possible they are not in network anymore,The provider office can usually confirm this.

 

[newbie2001]

First confirm they are actually enrolled in cigna.this is easy to do on Jarvis and other agent portals.If they are indeed enrolled in cigna then i bet it is an issue with cigna's online directory not being updated or errors since dropping the ppo's so it is very possible they are not in network anymore,The provider office can usually confirm this.

He are enrolled in Cigna. Have checked.

Directory and Sunfire states the provider is in network for the HMO

 

[somarco]

provider is in network is my point.

I understood your post and point 100%.

The question is, do you understand my response?

 

[newbie2001]

I understood your post and point 100%.

The question is, do you understand my response?

Yes, I understand. But according to the provider directory and Sunfire the doc is showing as in network.

 

[DonP]

I wrote a big patch of Cigna ppo's this aep before they all went no commission. That said I'd never write another Cigna plan and certainly no hmo with them . Cigna takes 2 1/2 weeks to approve a mapd . Maybe starting this aep hsbc who's taking them over is better .The Cigna regional admitted there directory is very inaccurate. I provide great service in many areas but now if I'm Effie on an area area I make the client call there drs and confirm they take the Medicare advantage I'm selling . I want them to hear directly from the office they take .

 

[newbie2001]

I wrote a big patch of Cigna ppo's this aep before they all went no commission. That said I'd never write another Cigna plan and certainly no hmo with them . Cigna takes 2 1/2 weeks to approve a mapd . Maybe starting this aep hsbc who's taking them over is better .The Cigna regional admitted there directory is very inaccurate. I provide great service in many areas but now if I'm Effie on an area area I make the client call there drs and confirm they take the Medicare advantage I'm selling . I want them to hear directly from the office they take .

Where does one get contact info for their regional I lost the number for mine and of course Corp support can't help. I have his name

 

[Special Agent]

He are enrolled in Cigna. Have checked.

Directory and Sunfire states the provider is in network for the HMO

I would start focusing on keeping member placated until you can move him to a plan for feb 1 that has all his providers so he doesn't end up calling cigna to complain.Use the directories as a guide post- thats what i like about working mostly in my local area and being very familiar with the local landscape if something doesn't look right in on an online directory it sticks out to me and i will call provider office.