You know it's time to get help for a drug or alcohol problem. But you've checked your bank balance, and you also know that you just can't pay for the…
Cigna is one of the largest names in the health care insurance business. According to company records, more than 95 million people worldwide count on Cigna for coverage.
But does bigger always mean better?
Insurance companies balance the needs of shareholders and stakeholders with the demands of consumers. Balancing the books means providing just enough coverage to keep patients happy without offering such generous benefits that the company won’t make a profit.
At one point, balancing the books was simple. Any condition with a twinge of blame attached to it wasn’t covered. That’s changed. Now companies, including Cigna, are required to provide coverage for addiction services. But you’ll need to understand your benefits and choose your provider carefully to ensure you don’t get a big bill at the end of your stint in treatment.
Are You Covered?
Per the Affordable Care Act, mental health services are essential benefits. That means companies that offer plans within the so-called “marketplace” for those without insurance have to include addiction treatment as a covered benefit. Since most insurance companies provide private companies plans similar to those in the marketplace, almost all companies cover addiction care. That’s part of the massive shift brought about through the law.
But just because you have coverage doesn’t mean you won’t have to pay for at least part of your care. In fact, if you choose the wrong venue or the wrong provider, you could be responsible for the entire bill.
Cigna offers at least three different types of plans to consumers, and the rules for accessing addiction care are different in each plan.
- Health maintenance organization (HMO): You’ll need a designated doctor — a primary care provider (PCP) — to coordinate your care. You’ll have to get treatment within a network chosen by Cigna. If you visit your doctor before you enroll or pick a facility that’s not part of the network, your bill gets bigger.
- Preferred provider organization (PPO): You’ll have a large network of doctors and providers to choose from, and you won’t have to visit a PCP first. You can step outside of that network, but if you do, you’ll pay more.
- Exclusive provider organization (EPO): As the name implies, this type of plan comes with strict limits on the network. You don’t need a referral from your PCP to access care, but if you choose a provider without a Cigna contract, you won’t have coverage.
You’ll need to know what type of plan you have and who is in your network before you enroll in a program. And you’ll also need to know about limits Cigna places on care.
In Florida and Pennsylvania, Cigna offers supplemental insurance policies that cover the cost of care that your insurance plan won’t. Unfortunately, Cigna’s policy won’t cover addiction care. If you were hoping to use this rider to supplement your standard insurance policy, this plan won’t be helpful.
Check Before You Enroll
No one wants a nasty surprise in the mail. That’s why it’s critical to understand your coverage type, your benefits, and your exemptions before you choose someone to help you with an addiction issue.
To do that, you can:
- Go online. Cigna offers an online portal for members. Here, you can input information about who you are and the plan you have, and Cigna representatives will explain your coverage for a specific type of illness. You can even use this portal to help you understand if a treatment provider you’re considering is part of Cigna’s network.
- Call for help. If you don’t understand the information you see online, it’s important to call. In fact, Cigna might appreciate the opportunity to clarify things for you. In 2017, Cigna came under fire for providing less-than-exceptional customer service, and the company worked hard to turn those numbers around. In 2018 alone, Cigna raised its customer satisfaction score by 11 percent, says Fierce Healthcare, putting it on par with industry standards.
Keeping that score up (and investors happy) will mean offering exceptional service to every customer from now on. You can take advantage. Whenever you have questions about your benefits and your coverage, call the number on the back of your identification card. Tell the operator who you are, what you need, and where you’re thinking of going. You should find out all about how much you’ll pay and whether there’s another option with a smaller price tag.
- Ask your provider. Your rehab facility should also give you information. Before you enroll, representatives will call Cigna to verify your benefits, make sure you have authorization paperwork, and are otherwise ready to start treatment under their care. Then, you’ll be given paperwork that lists how much your insurance should pay and how much your final bill will be.
If you have any questions about that paperwork, speak up. Addiction treatment teams are accustomed to serving clients who don’t know a lot about insurance, and they’re happy to answer your questions.
Using your benefits takes a little time, savvy, and homework. It’s vital to remember that you’re likely to save thousands of dollars. It’s work worth doing.
If you don’t feel up to the task of doing that research, ask a family member to tackle some tasks for you. Just remember to stay involved in the conversation. It’s your health — and your financial future — on the line, so you’ll want to be part of the solution.