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Cigna Preferred Care Management

Preferred Care Management is a process in which a medical plan case manager (nurse advocate) coordinates medical care and treatments to meet your and your family’s healthcare needs while providing cost savings to employees and employers. An example would be a nurse advocate finding extra support by connecting you with other helpful professionals, like social workers and pharmacists, and even arranging things like home care and medical equipment. Learn more about Preferred Care Management.

What can you expect?

• Guidance—Your nurse advocate will help you understand your medical condition, coverage, and out-of-pocket costs.
• Collaboration and Coordination—Your primary care doctors, specialists, and nurse advocate work together to make sure everyone is on the same page about your treatment plan. They arrange home care, access to durable medical equipment, caregiver respite services, and more. If you need to move between different care settings—like from a hospital to a skilled nursing facility—your nurse advocate can help coordinate that transition.
• Support—Along with explaining your condition, your nurse advocate will answer your questions about treatment options and medications. They will connect you with other helpful professionals, as needed, like social workers and pharmacists.

A key step: Prior Authorization

To ensure your care is covered, a number of services need prior authorization, which is Cigna's way of pre-approving treatment. This practice helps lower costs and avoids unnecessary medical procedures. Prior authorization is not the same as obtaining a referral to see a specialist. Preferred Care Management does not require referrals.

• In-network care—If you use a doctor in Cigna's network, your doctor's office is responsible for getting this approval for you.
• Out-of-network care—If you choose a provider outside the network, you will need to ask that provider to contact Cigna because prior authorization may be required.
• Common services requiring approval—Examples include hospital stays (non-emergency only), advanced imaging (like MRIs and CT scans), and specific pain management treatments. A regularly updated list of medical services that require prior authorization can be found here.

Routine outpatient behavioral health services will not require prior authorization.

Other things to know

• Cigna-member employees will be defaulted to a Preferred Care Management plan during fall Open Enrollment.
• Cigna medical plans without Preferred Care Management remain available with a 7 percent increase in employee cost share. The cost is higher without care management because the medical care received is not managed, resulting in higher costs. Employees will have the option of enrolling in a Cigna plan without Preferred Care Management during fall Open Enrollment or later if experiencing a qualifying life event.
• Preferred Care Management does not apply to retirees enrolled in the Indemnity/Medicare Supplemental plan. Preferred Care Management does apply to those who are Medicare-eligible and enrolled in Cigna's Open Access Plus In-Network (OAPIN) plan since their providers are in the Cigna network.