The terms of an individual's particular coverage plan document (Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document) may differ significantly from the standard coverage plans upon which these coverage policies are based. Or under the provider they are covering for? The program provides extensive and objective assessments through a network of credentialed, independent medical experts in all domains of medical care. Hello, Policies and Protocols for Providers | UHCprovider.com The general public is under the false impression that managed care companies do not provide coverage for new treatments, drugs, or devicesoften called experimental treatmentbecause they are expensive and unproven. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see In certain instances, this practice is considered to be experimental.We do not prohibit off-label use of approved medications, but use of certain drugs does require preauthorization. Health Plan Liability/Medical Director LiabilityThe issue of health plan liability for medical decisions first surfaced in the debate over the health care reform legislation during the Clinton presidency. Thank you. PDF LIMITATIONS/EXCLUSIONS (WHAT IS NOT COVERED) - Cigna We encourage all Cigna plan participants to seek treatment for non-emergency conditions as soon as possible. Usama Malik. Only when two or more drugs are determined to be therapeutically equivalent does cost become a consideration. Some of the alternative therapies of interest include acupuncture, naturopathy, biofeedback, and massage therapy. 8. Please help clarify, thank you. Mail: Cigna Phoenix Claim Services. Ultimately, it is the responsibility of the physician or group practice to know and follow the applicable guidelines. Locums typically fall into one of two categories for billing purposes: "true locums" and supplemental . Providers unhappy with the changes managed care has made in the way they are paid have raised the issue. Secondly, . Necessary mammograms, when ordered by a woman's physician or OB/GYN, are covered.
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