6 Major Changes Coming To All Cigna Plans in 2018

By: Dr. Seth Hosmer, DC

In an effort to educate our patients, we wanted to publish changes brought to our attention by the insurance company Cigna, effective January 2018.
Cigna has hired third-party administrator American Specialty Health (ASH). Part of ASH’s role is to provide Medical Necessity Review (MNR), and decide how much treatment you need for a given injury.

Here are the 6 biggest ways your plan will be affected:

  1. Medical Necessity Review begins after your 5th visit of the calendar year
  2. Chiropractic and massage therapy may only be rendered on separate dates of service in our office.
  3. After your fifth visit, only 15 minutes of massage therapy are generally covered by ASH.
  4. If your visits are not deemed “medically necessary” by ASH, you are responsible for the charges (as dictated by ASH and Cigna).
  5. There is a “medical necessity review patient packet” that they require the patient to fill out once a month to help them decide how many visits you need.
  6. This change will affect chiropractic, naturopathic, physical therapy, and acupuncture. There may be more disciplines affected, but these are the types that we are aware of.

We know this can be a confusing time, especially since most patients are completely unaware that this change is coming. For the sake of clarity, we have provided an example of what it may look like to seek treatment in 2018 through Cigna:

Example: Patient Jane Doe comes in for treatment for chronic lower back pain, and sees her doctor and massage therapist five times between January and February. After that point, Jane is pushed to Medical Necessity Review by Cigna and ASH. If coverage is denied, Jane is unable to come in for more visits until the appeals process is approved. Historically, this medical necessity review process can take months as our doctor and staff work to overturn the decision. During this time, our patients have to make the decision to either pay out of pocket or accept a major break in treatment.

What we recommend:

For patients who feel that this will create obstacles in receiving treatment, we encourage you to discuss your options with your employer or HR department. Many large companies have multiple plan options that you can choose from.
Additionally, if you need help understanding and picking plans during open enrollment this December, our staff is happy to help. Please do not hesitate to call us at (503) 227-2279.