What does IN-NETWORK mean? I still got charged a ton!

[mr_coffee]

So I went to find a doctor and I have CIGNA access plus insurance. I asked them if they were IN NETWORK with my insurance and they said YES.

But I just got a bill and my insurance only coverd 26% and I still owe like $400. On my insurance card it says if they are IN-NETWORK they cover 100%! so now I'm confused and MOST UPSET.

So what do I do now? Ask the doctors office why they didn't cover or do I call CIGNA?

[skippy13]

Call Cigna. They are the final authority on whether or not the doc is in network.

You need to check the official plan booklet to see whether or not the doc is on their list. The docs office will tell you what ever you want to hear, but the plan office will tell you like it is.

There should be an online list of in network providers. Not all of the docs in an office are on the list of network providers sometimes.

It could just be an error on the docs office staffs behalf, but check the official list of providers before jumping into it with anyone.

[sjean423]

Was this a bill from the doctor, or and insurance statement? If it was the insurance statement (I usually get these before the bill shows up) Look again at the statement. I have Cigna as well, and I HATE their statements. The ones from my other insurances were all much clearer.

Often the insurance DOES only cover a certain amount of the bill, surprisingly low, but then you don;t have to cover the rest, you have to cover what is laid out by your plan. Probably $20 for an office visit, and 20% of lab work. Etc.

On the front of my statements It will list total charges, Plan Liability and Patient responsibility. Is your "Patient responsibility" actually that high?

Another thing that may be going on, is your deductible. Even tho it is late in the year, your insurance only began this fall, right? So you still probably are working on your deductible. Ours is $250.

If it was a bill from the Doctor, have you received an explanation of benefits from Cigna yet?

If it was an insurance statement, I would call them first. Otherwise the doctors office is likely to tell you they just know what the insurance company told them.

If it was an actual bill from the doctor, look and see if you have the insurance statement. If so, and they agree, call Cigna. Otherwise start with the doctors office.



eta, good point Skippy, my note is assuming they really are in network. If they are out of network, but told you they were in network, you are going to have to deal w/ the doctor's office about this.

[mr_coffee]

Thanks for the info guys!

This is an explanation of the benefits and it says like, we covered 26%! You owe $400! Its not a bill from the docotors yet. I have medicare as my 2nd insurance I'm going to see if they can send the $400 to them to see if they can chop it down some more.

But yah I just trusted what the lady said but she never showed me any proof I just took their word for it.

This is the first time I dealt with real insurance before and finding a doctor. I was under my moms (she's also considered disabled + my medicare so I never had to pay anything really, althought we got shitty docs it was all free.


What worries me is I have another doc appointment with a different doctor at Santa Valley Medical Center and again I ask the person who deals with the pateitns and she said yes we are in network, but now I don't know for sure. CIGNA has a website but you are required to have a username/password that they never gave me. I'll have to give them a call tomorrow to get this sorted out.

Oh well you live and learn I guess.

[cheesecake]

CIGNA has a website but you are required to have a username/password that they never gave me. I'll have to give them a call tomorrow to get this sorted out.

If it is like my plan, you choose your user name and password. It is based on your social as well as policy number.

Verify the in-network. There may be a billing code issue so you got hit with the balance.

[McDuff]

You may be caught in what bit me lately. My insurance thought that Medicare should be primary and of course Medicare said ins should be.

If you are an active employee, then your ins is the primary. Only took me like 2 months to clear that up. I'd get on the horn to the ins and ask why they only covered 26%.

[sjean423]

Do you have a high deductible? If not, call the insurance, and ask why they only covered 26%. Is there a footnote on the back explaining what was disallowed? My Cigna statements make it confusing as to what was applied to the deductible, and there is so much info crammed onto the back it is easy to miss things, when the give 3 or 4 different comments to a line item.

We have had problems recently, once when the bill was incorrectly coded for treatment our insurancee didn;t cover, and another time when the bill was sent in with the wrong name on it, and the insurance balked at paying for a physical for the same child 2 months in a row, when it was actually appointments for siblings. (Don;t blame them actually. They paid it when it was corrected.)

So don;t just pay it, it very well might be wrong.

[LaMemChose]

CIGNA can be a major, big time PITA. Prep to fight with them to have your med needs covered.

How big is your deductible? That could be why your out of pocket is so high.

[mr_coffee]

CIGNA was very cool. I explained to them that the people at the doctors office told me they were in network, I told them I asked them several times (which I did and they said yes we are). The nice lady said well we can do a 1 time exception for you and cover the costs of the doctor bill in full because they lied to you. We can only do this one, from now on you need to check on our website or call us to check for you to see if they are infact in network or not.

I said thank you and she even checked that my next doctor was infact in-network, wee!

[addiesue]

I had Cigna and they were awesome. They bought a stander and a basically anything I needed. The I got divorced and lost my healthcare. ):

[ColonusFan]

...

This is the first time I dealt with real insurance before and finding a doctor. I was under my moms (she's also considered disabled + my medicare so I never had to pay anything really, althought we got shitty docs it was all free.

....

Dear Cory,

After reading this I wondered if you are working above SGA and receiving Medicare. If so realize that you are ticking away your 93 months of extended coverage for Medicare. SSA and CMS will not tell you when Medicare runs out, so just be careful about "depending" on Medicare.

Just as a friendly reminder,