Network vs. Non-Network Care
One of the best features of our medical plan is the freedom to choose any medical services provider without the hassle of obtaining referrals. Participating employees may choose network services, non-network services or a combination of both. Our plan offers access to a nationwide network of doctors and hospitals under the CIGNA (GWH-CIGNA) Open Access Plus network. When using members of this network, covered participants pay only a $15 co-pay or 10% co-insurance, depending on the type of service. When searching for providers on the website or inquiring into a provider’s participation via phone, please ensure you use the Open Access name.
Any service from a health care provider not participating in the network is a "non-network service." Participants may always opt for non-network services, howeer, benefits and utilization procedures differ from those of network care. The greatest cost savings will be realized if you remain in network.
Take Control with myCIGNAforhealth
Whether you need to check the status of a claim, order a prescription or get directions to the doctor's office, myCIGNAforhealth.com puts you in control of your health care. Register or sign in for personalized plan information and wellness tools designed to help you get the most from your benefits.
Features of the website include the ability to
View current and past claims
View benefits information
Request or print ID cards
Access planning tools
We realize managing your heath can be difficult. Especially if you have a chronic condition. Another wonderful feature of the myCIGNAforhealth website are programs that encourage you to become active in managing your health, and work with you to set and achieve health-improvement goals. You can either enroll yourself in this beneficial program or a CIGNA physician/nurse may contact you directly to seek your enrollment in the program. The program offers direct access to a nurse 24/7, customized information to help you effectively manage your condition, sample questions to use when meeting with your doctor, and even suggestions that may help reduce your overall out-of-pocket costs.
Another helpful too on myCIGNAforhealth is the ability to get information on and manage your pharmacy benefits. Selecting the "Pharmacy" tab allows you to
Review pharmacy benefits
View your benefit coverage details and see the amount you will pay for each category of prescription medications.
View the last 12 months of prescription history for you and your dependents under 18 years old. Dependents that are over 18 years old will need to create a separate account on myCIGNAforhealth to view their individual prescription information and history.
Take advantage of convenient home delivery for your maintenance medications through CIGNA Home Delivery Pharmacy. Save money and valuable time by ordering 90-day supplies. Manage your medications online- you can track order and shop dates and see the number of refills you have left.
Prescriptions: Ask Questions - Shop Around
Americans see their doctors more than 890 million times each year, and two-thirds of office visits result in a prescription. So it makes sense to compare prices before filling yours. Here are some things you can ask your doctor or pharmacist about trying, to keep yourself physically and financially healthy.
Switch to generics when available
Ask about different brands that have the same effectiveness; there may be a less expensive over-the-counter (OTC) drug with similar benefits
Consider buying in larger quantity
Order a higher dosage, then split pills in half, if possible. Consult your doctor first, since this may not be appropriate for your medication
Search for the best prices online, via mail-order, and at retail pharmacies. If you decide to order medication online or purchase from multiple sources, talk to your doctor/pharmacist first
Durable Medical Equipment
Have you ever had a sprained ankle and your physician provides you with crutches? How about a sprained wrist for which your doctor gives you a splint? These items are not part of your doctor's services. In fact, durable medical equipment (DME) companies provide these items to your physician. Therefore, you will receive a separate bill from the DME provider. And in most cases the DME provider IS NOT a Great West participating provider. The most commonly used DME provider is Superior Medical Equipment, and they ARE NOT a participating provider.
So what are your options? If this has already happened to you, your only recourse is to contact your physician's office and file a complaint. However, chances are, prior to providing you with the equipment, your physician gave you paperwork that indicated the equipment was from a separate provider. Therefore, the charges will be your responsibility. If you are faced with this situation in the future, you can request a prescription for the DME from your physician. Once you have the prescription, you should call CIGNA, who will give you the contact information for a participating DME provider. The DME providers who are contracted with CIGNA are able to overnight the equipment to you.
Generally, if these items are provided to you from a hospital, they are part of the hospital's charges. But it's always better to ask than receive a unexpected bill.
Explanation of Health Care Benefits
Each time a claim is submitted to CIGNA for yourself or an insured family member, CIGNA notifies you by means of an Explanation of Health Care Benefits (EOB). It is very important that each time you receive an EOB, you take the time to carefully review the information contained on the form. You will want to ensure the claim which has been submitted is for yourself or a family member, determine your portion of the cost of services, or ensure no additional information has been requested on the part of you or the provider. It is imperative that you maintain the EOB in the event billing discrepancies arise with the providers office.
Please remember that it is your responsibility to verify your providers’ participation in the GWH-CIGNA Open Access Network. Provider directories and a compete summary plan description can be found at mycignaforhealth.
Last updated October 24, 2011