Effective June 1, 2020, HCA TriStar will no longer be part of Cigna’s provider network LocalPlus. Instead, LocalPlus members in Middle Tennessee will now have access to in-network hospital care at St. Thomas facilities and professional services with St. Thomas Medical Partners. This is in addition to existing LocalPlus providers, including Vanderbilt University Medical Center, Vanderbilt Wilson County Hospital, Vanderbilt Children’s Williamson Medical Center, Nashville General Hospital Meharry, Northcrest Medical Center, and Erlanger.
Cigna and HCA TriStar began renewal negotiations for all their product lines in November 2019. Negotiations ended with Cigna and HCA TriStar unable to come to new contract terms for LocalPlus. Cigna subsequently added St. Thomas and St. Thomas Medical Partners under more favorable terms.
Benefits Administration does not contract directly with hospitals or providers. Both contracts with Cigna and BCBST use the carriers’ commercial networks. Benefits Administration was concerned about the network change occurring at this time, conversations with Cigna regarding the issue and contacted HCA TriStar directly during the negotiations to request both parties work to a satisfactory solution, including a request for a limited agreement just on behalf of the state. Unfortunately, both parties were unable to reach an agreement.
At this time, heads of contract for affected members should have received a letter from Cigna if they sought care at an HCA TriStar facility within the past 12 months. The letters included finding a new in-network provider, member FAQs, and information regarding eligibility for continuity of care.
The Continuity of Care program lets you continue to get in-network coverage for certain medical treatment from your provider or at a hospital for a specific period of time even after the provider or hospital leaves your plan’s Cigna network. This means that the plan will pay the provider or hospital as if they were still in-network, and you will pay your in-network deductible and coinsurance amounts. However, you will have to pay more than usual if the hospital decides to bill you for more than the maximum allowable charge. There are two ways to find out more:
- Call the number on your Cigna ID care, 800-997-1617. Let the Customer Service advocate know you’re in the middle of treatment. They’ll work with you to determine your eligibility for Continuity of Care. They can also help you complete the request form.
- Use myCigna.com
a. Go to myCigna.com and click Forms.
b. Scroll to the bottom of the page to All Other Forms.
c. Select Medical, and the choose Continuity of Care Form.
d. Print it, and fill it out, or request that your provider fill it out.
e. The form will have the mailing address you must send it to.
Once you submit the request form, Cigna will send you a letter with a decision. If you have any questions, they should be able to help. Please call the number on your Cigna ID care. Customer Service is available 24/7.
There is a deadline for requesting Continuity of Care. You must apply within 30 days of your health care provider’s termination date of June 1, 2020. This is the date that your provider is leaving your plan’s network.
If Continuity of Care is approved before July 1, 2020, you may be able to receive in-network coverage for care from the hospital and/or your provider for up to ninety (90) days.
Please visit this website for additional information: https://www.tn.gov/partnersforhealth/health-options/carrier-network.html
At the May 21, 2020, State Group Insurance Committee meeting, the committees authorized amending the plan documents to allow members on one of the narrow networks – BCBST S or Cigna Local Plus (LP) to elect to change their insurance plan to the broader Cigna Open Access Plus (OAP) network if the member is on a network that has lost 5 or more hospital providers from January 1, 2020, through June 1, 2020.
Compensation and Benefits staff will continue to provide you with the latest information regarding this issue. You may also contact us to help answer your questions at, 615-256-4533 or outside of Davidson County 800-251-8732.