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PSA: The Quirks of Cigna Dental Insurance

Discussion in 'Off Topic' started by SageBrush, Oct 19, 2016.

  1. SageBrush

    SageBrush Active Member

    Joined:
    May 7, 2015
    Messages:
    3,693
    Location:
    Colorado
    I cannot say for certain that Cigna follows industry wide practices but caveat emptor:

    I own a PPO insurance policy that gives me the flexibility to choose any dentist for care. It turns out that Cigna calculates reimbursement to me as a product of a 'discount' times a dental charge per code. So e.g.,

    If the dental code is $100,
    And the discount is 50%,
    I'll receive $50 from the insurance company.

    The tricky (and mostly hidden) part relates to the dental code dollar amount. It turns out that Cigna sets the amount for a code as follows:
    • If the dentist is out of network, the amount is set equal to the average going rate for that locale.
    • If the dentist is part of Cigna but does not accept the specific Cigna plan, the rate is set "close to," but not exactly equal to the amount that the dentist has contracted to accept for the same code in other Cigna plans the dentist does accept.
    • If the dentist is part of the Cigna network and accepts the specific insurance plan, an individual contract between the dentist and Cigna determines the code amount. This is the most unexpected, to find that participating, in-network dentists that accept MY plan do not charge the same amount. E.g., two local dentists that are both myPLAN providers vary by 10% for an expensive crown. I will call a couple more dentists today ;-)
    Bottom line ? The only way to know charges and reimbursements ahead of the bill is to query every candidate dentist individually; the network affiliation is inadequate information. Cigna will provide code charges by telephone but the customer has to check one dentist at a time.

    Potentially even more problematic is trying to pick an insurance policy since I don't know if this code charge information is available to non policy holders.
     

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