Remind your customers why they chose a PPO

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Cigna Medicare Advantage

Let your customers know how to best use their PPO benefits

We are proud of the breadth and depth of our provider networks that we offer to our Medicare Advantage customers. With our plan offerings, many customers across the country choose a Cigna Medicare Advantage Preferred Provider Organization (PPO) plan for increased flexibility in seeing an out-of-network provider. Even though these plans provide coverage for these types of visits, we continue to get a lot of questions from customers who don't fully understand the benefits of their PPO plan. Give your customers a call to go over the answers to some of the most frequently asked questions for PPO benefits.

While there is some coverage for out-of-network visits, customers save time and money when choosing in-network providers. Many out-of-network providers will not file claims on behalf of the customer, taking even more time for the customer to complete and submit the claims paperwork.

Cigna will cover services as long as they are covered benefits and are medically necessary. But keep in mind, they may still cost more than going to an in-network provider. To avoid unnecessary costs, encourage your customer or the provider to ask Cigna for a coverage decision before the visit or procedure.

Also, make sure your customer understands that an out-of-network provider is not contracted with Cigna for Medicare Advantage, and that provider has no obligation to accept the customer as a patient unless it is for emergency care. Your customer should ask the provider if they are willing to accept and provide care for a Cigna customer. If the customer is not an established patient with a provider, he or she should also ask the provider if they are currently accepting new patients.

We update our provider directories each day for the most accurate, up-to-date listing of in-network providers. We break these out by state to provide information that is valuable to customers in your area. To find today's directory, log in to Producers' University and search the resource library for "provider directory" in the state you want to view.
 
Cigna Medicare Advantage

Let your customers know how to best use their PPO benefits

We are proud of the breadth and depth of our provider networks that we offer to our Medicare Advantage customers. With our plan offerings, many customers across the country choose a Cigna Medicare Advantage Preferred Provider Organization (PPO) plan for increased flexibility in seeing an out-of-network provider. Even though these plans provide coverage for these types of visits, we continue to get a lot of questions from customers who don't fully understand the benefits of their PPO plan. Give your customers a call to go over the answers to some of the most frequently asked questions for PPO benefits.

While there is some coverage for out-of-network visits, customers save time and money when choosing in-network providers. Many out-of-network providers will not file claims on behalf of the customer, taking even more time for the customer to complete and submit the claims paperwork.

Cigna will cover services as long as they are covered benefits and are medically necessary. But keep in mind, they may still cost more than going to an in-network provider. To avoid unnecessary costs, encourage your customer or the provider to ask Cigna for a coverage decision before the visit or procedure.

Also, make sure your customer understands that an out-of-network provider is not contracted with Cigna for Medicare Advantage, and that provider has no obligation to accept the customer as a patient unless it is for emergency care. Your customer should ask the provider if they are willing to accept and provide care for a Cigna customer. If the customer is not an established patient with a provider, he or she should also ask the provider if they are currently accepting new patients.

We update our provider directories each day for the most accurate, up-to-date listing of in-network providers. We break these out by state to provide information that is valuable to customers in your area. To find today's directory, log in to Producers' University and search the resource library for "provider directory" in the state you want to view.

Why are you sending this?
 
wehotex said:

Why are you sending this?

I "posted" it as I thought it was odd. I have a lot of clients on PPOs and haven't had very many issues. Also I wasn't sure if this is just an issue Cigna is having, or other carriers as well.
 
wehotex said:

Why are you sending this?

I "posted" it as I thought it was odd. I have a lot of clients on PPOs and haven't had very many issues. Also I wasn't sure if this is just an issue Cigna is having, or other carriers as well.

agreed. It is Odd. I wasn't even aware that Cigna offers PPO?
 
wehotex said:

Why are you sending this?

I "posted" it as I thought it was odd. I have a lot of clients on PPOs and haven't had very many issues. Also I wasn't sure if this is just an issue Cigna is having, or other carriers as well.

I usually tell people if out of network is important Med supp would be the better option

I've been in this since 2010 since then I have seen them out of network cost-share go up and up some are now 50% cost share out of network

Some carriers even require a primary on the app now for PPO

Besides that, I have had a few (not many) that had an issue without of network being paid its not often maybe 2 or 3 over 10 years but I also had a handful where they could make an appointment because the doc would not take out of network

Clearly, PPO is not really meant for that type of flexibility as much as it used to be and companies try and push for in-network anyway

PPO is usually a larger network

and My clients tell me they have less preauth than HMO in most cases
 
Some carriers are extending out of territory network benefits on HMO's but the main reason for some of my clients to choose a PPO (not many have) would be they would like to have network benefits while out of territory, and PPO's usually allow that, assuming national network participation of the provider. A few of them have limited out of network benefits with copays like specialists and behavioral health counseling. Some have eliminated out of network deductibles. One has identical in/out of network coverage, but of course the higher total out of pocket if expenses rise to that level. I make sure to point out that the large % of out of network charges the client would assume, for example: hospitalization, needs to be emphasized. Also that out of network providers need to accept Medicare eligible patients and contract with Medicare, agreeing to Medicare allowable charge rules.
 
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We don't have MA with Cigna in my area, but we do have one company in particular telling agents to tell people that they can go to any provider who accepts Medicare with their PPO plan. They want us to push that plan without providers showing in network. This is terrible advice as the provider has no obligation to take the plan. I would assume some agents are using that same marketing line to push plans and it is probably causing complaints to Medicare. I agree with vic on OON coverage and recommending Med Supp. I've switched a few of those PPO for people who did want an advantage to a different company or plan that actually included the doctors they see.
 

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