Open Access Plus Open Access Plus In-Network Cigna Care Network

434 Pages·2017·7.23 MB·English

Open Access Plus
Open Access Plus In-Network
Cigna Care Network®
Important plan information for:
The Cleveland, Akron, Canton, Warren and Youngstown Areas
Offered by Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.
Contents 1
Contents
Fall 2018
Introduction 3
(cid:2)
Cigna LifeSOURCE Transplant Network 8
Health Care Provider Compensation 11
Non-Discrimination 12
Service Area 15
How to Read the Provider Listing 16
Primary Care Service Providers 17
Obstetricians/Gynecologists 118
Specialists 136
Hospitals 346
Mental Health / Substance Abuse 347
Pharmacies 391
Vision Care 393
Other Services 394
Index 407
Go to
www.cigna.com
to create an
on-line
personalized
directory.

Introduction 3
Introduction
WHO WE ARE
n Cigna is a global health service company. We’re here to help you and your family live healthier,
more financially secure lives. We’re excited to be a part of your health and wellness journey.
n We are where you are. Cigna has a national presence, but we also have a local focus in most areas
This means local medical directors and health services representatives work to provide you with
access to quality care where you live and work.
WHAT YOU CAN EXPECT
n Access to quality health care. Before joining the Cigna network, health care providers must meet
Cigna standards through a process we call credentialing. We regularly review credentials to make
sure the providers continue to meet these standards.
n Outstanding customer service. We’re here 24/7/365. Contact us online at www.cigna.com, by
phone or by app. However it’s convenient for you.
ABOUT THIS DIRECTORY
This directory includes a list of health care providers in your local area who are in the Cigna Open
Access Plus (OAP) network. This directory also tells you what you need to know about using your new
plan. You may not need all this information now. But make sure you keep this directory in a safe place.
You may want to look at it again later.
Just because a provider is in this directory, it doesn’t mean that your plan covers all the services that this
provider offers. Always look at your plan materials (such as your Summary of Benefits) to see what
your plan covers. You can also contact Cigna Customer Service for information about what your plan
covers. Call us using the number on the back of your ID card or go online to www.cigna.com, and for
current Cigna customers at www.mycigna.com.
Use this directory to:
n search for OAP network providers, hospitals and other health care professionals and facilities.
n look to see what providers are accepting new patients.
n download your own personalized directory to have on hand when you need it.
n find hospital scores for specific conditions/procedures through Cigna “Centers of Excellence” (for
current customers only at www.mycigna.com).
4 Introduction
Because this provider directory has been printed and mailed, it may include providers who are no longer
in-network. To see the latest, most up-to-date, list you can look online. We update our online lists often,
and you may find more providers than the ones listed here. You can also call us.
n Go online to www.Cigna.com and click Find a Doctor.
n Use the myCigna® website or app (current customers)
n Call us. Our Customer Service Advocates are available 24/7/365, and are happy to help you find an
in-network provider in your area. You can call us toll-free at 1.800.Cigna24 (1.800.244.6224).
The pages that follow contain:
n Information about your ID card
n How to choose and work with your provider
n Who to call if you need help or language assistance
n Information about the Cigna LifeSOURCE Transplant Network®
n Information about how we pay our providers
n Non-discrimination policy
YOUR CIgNA ID CARD
You get your Cigna ID card after you enroll. Keep your ID card with you at all times. Show it whenever
you visit a health care provider or facility. Always check your ID card if you need help finding the
name of your Cigna network and benefit plan. This will help you identify the health care providers that
are in-network for your plan.
CHOOSINg A PROvIDER TO BE YOUR PRImARY CARE PROvIDER
We encourage you to choose a Primary Care Provider (PCP) to be your personal provider. Each covered
member of your family can choose his or her own PCP. Your first stop for care should be your PCP
or personal provider. He or she can help decide if you need specialty care or hospitalization. In the
event of a true emergency, dial 911 or go to the nearest hospital.
n Your PCP serves as a “home base” for basic care – a source of advice and direction.
n Your PCP also coordinates your care - from preventive checkups and routine medical care to
specialized care and hospitalizations. He/she also keeps your medical history.
n If your plan requires referrals, your PCP will also provide you with referrals to specialists when
necessary. See your plan materials to learn whether your plan requires you to have a referral before
seeing a specialist.
n Your PCP doesn’t have to refer you to an OB/GYN. As part of your plan, you can visit an in-
network OB/GYN at any time, without a referral, even if your plan requires referrals to other types
of specialists
n You can change your PCP at any time, for any reason.
Introduction 5
YOUR SUmmARY Of BENEfITS
Your Summary of Benefits explains what your plan covers. It includes information about what medical
benefits you have. It also shows you what services your plan covers. Read this information so you know
whether you have prescription drug coverage, coverage for mental health and substance abuse, and/or
vision care coverage as a part of your Cigna plan.
LANgUAgE ASSISTANCE
If you have trouble understanding English, we offer language assistance and interpretation services at no
cost to you. For help, please call the Customer Service number on the back of your ID card. If you don’t
have (or can’t find) your ID card, please call 1.800.244.6224. If you have hearing or speech loss and use
Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS
operator.
Si le cuesta comunicarse en inglés, ofrecemos asistencia de idioma y servicios de interpretación sin
costo alguno para usted. Para obtener ayuda, comuníquese con el número de Servicio al cliente que
figura en la parte de atrás de su tarjeta de identificación. Si usted no tiene o no puede encontrar su tarjeta
de identificación, llame al 1.800.244.6224. Si tiene algún impedimento auditivo o del habla y desea usar
el servicio de retransmisión de telecomunicaciones (TRS, por sus siglas en inglés) o un teléfono de texto
(TTY, por sus siglas en inglés), marque 711 para comunicarse con un operador del TRS.
PROvIDER NETWORk SELECTION CRITERIA
For more than 125 years, Cigna has been committed to building a trusted network of health care
providers. The providers, hospitals, facilities and other health care professionals we contract with must
meet certain credentialing requirements and agree to our billing rates. This helps make sure you have
access to quality, cost-effective care. To build our network, we look at how many primary care and
specialty providers are in a specific area. We also look at what hospitals, labs, and other facilities are
in that area. Our goal is to build a network that gives you choice and convenient access to treatment
and services. Provider networks vary by state and plan and include providers, hospitals, and health care
facilities in your local area. Initially, we don’t use quality or cost measures or customer experience
ratings to choose providers.
visit www.cigna.com, or www.mycigna.com for current customers, to search
for in-network providers. You can also find more information on health topics,
preventive care and learn more about your plan’s benefits and programs.
6 Introduction
IN-NETWORk vS. OUT-Of-NETWORk HEALTH CARE PROvIDERS
In-Network Costs:
You may save money using in-network providers. In-network providers have a contract with Cigna.
They agree to charge Cigna customers certain rates. These rates are usually less than what they charge
non-customers. So you’ll usually pay less out of pocket using in-network providers. Your plan may
require that you pay a copay, deductible or coinsurance. You’re responsible for paying these amounts.
In-network providers shouldn’t bill you for anything else. For example, they shouldn’t require you to
pay any difference between their billed charges and the Cigna contract rate. If they do, we call this
balance billing. In-network providers shouldn’t balance bill.
Out-of-Network Costs:
Some plans include out-of-network benefits. This means you can use a provider outside of the Cigna
network. Out-of-network providers don’t have a contract with Cigna. This means they can charge
whatever rates they want. If your plan includes out-of-network benefits, and you use an out-of-network
provider, you’ll probably pay more. You’ll be responsible for paying the difference between what they
charge and what an in-network provider charges. If your plan doesn’t include out-of-network coverage,
the provider may bill you directly for the full cost of services. You’ll then be responsible for the full
costs (except in the case of emergency services).
What happens if a provider changes their network status?
It’s always a good idea to check with a provider (before scheduling your appointment or receiving
services) to make sure he or she is in the Cigna network. If you see a provider that leaves the Cigna
network, you may be subject to the same out-of-pocket, out-of-network costs described above. If you’re
currently seeing a provider for an ongoing condition or are pregnant, and your provider leaves the Cigna
network, contact us. We may consider Continuity of Care Coverage for a defined period of time. You
must apply for continuity of care using the Continuity of Care/Transition of Care Request Form. Please
check your Summary of Benefits or call the Cigna Customer Service at the toll-free number on the back
of your Cigna ID card.
Out-of-Network Reimbursement:
When we pay providers who are out-of-network, we look at several things.
n What the industry standard charge is for the specific treatment or service
n What the provider is charging
n A comparison of charges by other similar providers
n What we typically pay an in-network provider for the same type of covered service in the same
geographic region
n Medicare reimbursement rates.
The fee we pay to an out-of-network provider is the Maximum Reimbursable Charge. The out-of-
network provider may bill you the difference between their charge and the Maximum Reimbursable
Charge. This is in addition to any required deductibles, copayments and coinsurance.
Introduction 7
Out-of-network providers based at in-network facilities
Even though a facility may be in-network, it doesn’t mean all the healthcare providers who work
there are in-network too. For example, if you ever need to go to the hospital, some providers such as
anesthesiologists, radiologists, and laboratories may not be in-network. If you get care from these
out-of-network providers, you may be responsible for paying all or part of the costs. This would be in
addition to any amounts due for copayments, coinsurance, deductibles, and non-covered services. It’s
always a good idea to ask ahead of time whether the providers you’re using are in-network. Call us
anytime and we’ll be happy to help. Use the toll-free number on the back of your Cigna ID card.
Network Name:
For current customers, always refer to your Cigna ID card for help to determine the name of your Cigna network
and benefit plan or to identify the health care providers that are in-network for your plan. If you are a potential
customer, please refer to the benefit plan and network names included in your enrollment materials to identify
which health care providers are in network for the plan you are considering.
Network Tiers:
Your plan does not have separate tiers of in-network providers. However, if you have the Cigna Care Network,
your network may include certain types of specialists with a Cigna Care Designation. When you receive
covered services from a designated doctor, the in-network coverage level applies and your copayments or
level of coinsurance may be lower than if you chose a non-designated doctor. To learn more about Cigna Care
Designation including the cost and quality measures utilized to assess doctors, please visit www.mycigna.com
(current customers) or www.Cigna.com (potential customers).
The listing of a provider in this directory does not guarantee that the services provided by that provider
are covered under your specific medical plan. Check the materials which describe your particular plan
benefits, or call Cigna Customer Service for information about the services covered under your plan
benefits. If you have questions or need assistance, please contact Customer Service at the toll-free
telephone number listed in your enrollment materials or on your Cigna ID card.
8 Cigna LifeSOURCE Transplant Network
Cigna LifeSOURCE Transplant Network
®
As a Cigna customer, you have access to the Cigna LifeSOURCE Transplant Network®. It’s a network
of organ and tissue transplant centers. Developed by a team of Cigna clinical professionals, the
transplant network includes respected hospitals and medical centers throughout the country.
Cigna LifeSOURCE contracts with select independent transplant facilities that are nationally recognized
for their quality care. We have more than 165 facilities in our network that provide access to transplant
programs coast to coast. Each Cigna LifeSOURCE program is carefully chosen to participate in the
Cigna LifeSOURCE Transplant Network and must continue to meet our established quality standards.
All programs must maintain minimum volumes, designated patient and graft survival outcomes,
appropriate designations, and show expertise in managing individuals on the waiting lists.
Customers needing a transplant are assigned to one of our nurse case managers in our transplant case
management unit. These managers have clinical experience in transplant, hematology/oncology, home
health care, dialysis, critical care and community care. They have special training to manage complex
transplant cases.
Services the Transplant Case Management Unit offers:
n Help finding a health care provider
n Help managing your coverage for consistency in service and benefit administration
n Access to dedicated resources for complex areas of medicine
n Information to help you understand your treatment choices
n Help with paperwork and other administrative tasks
In some instances a travel benefit is offered as a feature of the program. Your case manager can tell
you if you are eligible for this benefit. As a Cigna customer, you can have access to these services when
they are handled through your provider and your transplant case manager.
In-network benefits
You may not receive the in-network level of coverage for all types of transplants at all hospitals. In
addition, our network of locations changes frequently. For the most current listings with the programs
covered at the in-network coverage level, please visit www.cignalifesource.com or call Cigna
LifeSOURCE Customer Service at 1.800.668.9682. Also, not all programs at a Cigna LifeSOURCE
Transplant Network medical center are available to all customers. Please call Customer Service
at 800.668.9682 for more information and to check on what your plan covers. If you’re already in
transplant case management, please call your case manager directly.
Cigna LifeSOURCE Transplant Network 9
Alabama UCSD Medical Center, georgia Louisiana University of Minnesota
University of San Diego AU Medical Center, Ochsner Clinic Medical Center
Alabama Hospital, UCSF Benioff Augusta Foundation, New and University of
Birmingham Children’s Hospital Children’s Healthcare Orleans Minnesota Masonic
Oakland of Atlanta Tulane Medical Center, Children’s Hospital,
Arizona UCSF Medical Center Emory University New Orleans Minneapolis
Banner - University and UCSF Benioff Hospital, Atlanta
Medical Center, Children’s Hospital, Northside Hospital, maine missouri
Phoenix San Francisco Atlanta Maine Medical Center, Barnes-Jewish Hospital,
Banner - University Piedmont Hospital, Portland St. Louis
Medical Center, Colorado Atlanta Children’s Mercy
Tucson Children’s Hospital maryland Hospital, Kansas
Mayo Clinic Scottsdale Colorado, Aurora Illinois Johns Hopkins City
Phoenix Children’s Porter Adventist Lurie Children’s Hospital, Baltimore Research Medical
Hospital Hospital, Denver Hospital of Chicago University of Maryland Center, Kansas City
HonorHealth Scottsdale Presbyterian St. Luke’s Northwestern Memorial Medical Center, St. Louis Children’s
Shea Medical Medical Center, Hospital, Chicago Baltimore Hospital
Center Denver Rush University SSM Health - St. Louis
St. Joseph’s Hospital, University of Colorado Medical Center, massachusetts University Hospital
Phoenix Hospital, Denver Chicago Beth Israel Deaconess St. Luke’s Hospital of
University of Chicago Medical Center, Kansas City
Arkansas Connecticut Medical Center and Boston
University of Arkansas Hartford Hospital Comer Children’s Brigham and Women’s Nebraska
for Medical Yale-New Haven Hospital, Chicago Hospital and Dana Nebraska Medical
Sciences Medical Hospital University of Illinois Farber Cancer Center, Omaha
Center, Little Rock Hospital, Chicago Institute, Boston
Delaware New Hampshire
Children’s Hospital,
California Alfred I. duPont Indiana Boston Dartmouth - Hitchcock
California Pacific Hospital for Indiana Blood Lahey Clinic Medical Medical Center,
Medical Center, San Children, and Marrow Center, Burlington Lebanon
Francisco Wilmington Transplantation, Massachusetts General
Cedars-Sinai Medical Beech Grove Hospital and Dana New Jersey
Center, Los Angeles District of IUH University Farber Cancer Hackensack University
Children’s Hospital Los Columbia Hospital, Institute, Boston Medical Center
Angeles Children’s National Indianapolis Tufts - New England Newark Beth Israel
Children’s Hospital of Medical Center IUH Methodist Medical Center, Medical Center
Orange County Medstar Georgetown Hospital, Boston Robert Wood Johnson
City of Hope National University Hospital Indianapolis UMass Memorial University Hospital,
Medical Center, Medstar Washington Riley Hospital for Medical Center, New Brunswick
Duarte Hospital Center Children at IUH, Worcester St. Barnabas Medical
Keck Hospital of USC, Indianapolis Center, Livingston
Los Angeles florida michigan
Loma Linda University All Children’s Hospital, Iowa Henry Ford Hospital, New York
Medical Center and St. Petersburg University of Iowa Detroit Albany Medical Center
Children’s Hospital Cleveland Clinic Hospital and Karmanos Cancer Erie County Medical
Lucile Salter Packard Florida, Weston Clinics, Iowa City Center, Detroit Center, Buffalo
Children’s Hospital, Florida Hospital, University of Michigan Memorial Sloan-
Palo Alto Orlando kansas Health System, Ann Kettering Cancer
Rady Children’s H. Lee Moffitt Cancer University of Kansas Arbor Center, New York
Hospital, San Diego Center, Tampa Hospital, Kansas William Beaumont Montefiore Medical
Ronald Reagan UCLA Jackson Memorial City Hospital, Royal Oak Center, Bronx
Medical Center, Los Hospital, Miami Mount Sinai Hospital,
Angeles Mayo Clinic kentucky minnesota New York
Scripps Green Hospital, Jacksonville Jewish Hospital, Hennepin County New York Presbyterian
La Jolla Shands Hospital, Louisville Medical Center, Hospital,
Sharp Memorial Gainesville University of Kentucky, Minneapolis (Columbia)
Hospital, San Diego Tampa General Lexington Mayo Clinic Rochester New York Presbyterian
Stanford University Hospital Hospital, (Cornell)
Medical Center University of Miami New York University
Sutter Medical Center, Sylvester Cancer Medical Center
Sacramento Center Roswell Park Cancer
Institute, Buffalo