Is it considered In-Network?

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Shelley - 25 Oct 2004 20:15 GMT

My husband has Cigna Healthcare through employer. Our residence is in
NJ, but I am currently going to school in TN. Last time, when I saw
my PCP in NJ, he found a lump in my breast and prescribed a mammogram.
We called around and the earliest available appointment is around end
of Dec. So I called several places in TN and one can get me in next
week.

Here comes the insurance problem. We called Cigna and got conflicting
info. On one hand, we were told that since I saw our PCP first, I can
use his referral to have my mammogram done in TN and still be
considered in-network service. On the other hand, we got negative
reponse.

While we're working with them, I wonder if anyone here who had similar
experience would like to share your experience. Thanks!

-Shelley

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Mark & Steven Bornfeld DDS - 25 Oct 2004 20:36 GMT

> My husband has Cigna Healthcare through employer. Our residence is in
> NJ, but I am currently going to school in TN. Last time, when I saw
[quoted text clipped - 8 lines]
> considered in-network service. On the other hand, we got negative
> reponse.

If the mammogram facility is in the network and the referral wasn't
bungled somewhere, it should be in-network. What is Cigna telling you?

Steve

> While we're working with them, I wonder if anyone here who had similar
> experience would like to share your experience. Thanks!
>
> -Shelley

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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Shelley - 26 Oct 2004 06:07 GMT

The mammogram facility is in the Cigna network.

The negative response we got from cigna was that if I see a doctor out
of NJ, it will by no means be out-of-network.

The Cigna agent who thinks we are qualified for in-network asked for a
special written authorization from our PCP. OK! That was done! Then
they asked for permission from our NJ local radiologist. It totally
does not make sense to us. While we are still working on it, we were
informed today that a special committee was formed for my case and we
will hear the decision in a week!

What frustrate us most is that no one seems to know exactly what needs
to be done. I really don't think I am the first such case for Cigna.
I tried to search internet resources, hoping to find some written
documents as a guidance. So far, no luck. Do you have any idea where
I can possible find such documents? Thanks!

-Shelley

> > My husband has Cigna Healthcare through employer. Our residence is in
> > NJ, but I am currently going to school in TN. Last time, when I saw
[quoted text clipped - 18 lines]
> >
> > -Shelley

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Jeff - 26 Oct 2004 13:12 GMT

You haven't told us what your husband's human resource department has done.

The human resource department is the purchaser of the insuance and who can
most effectively talk to the Cigna about this.

So they are the key people who will help you get this covered.

Jeff

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