Is anyone else seeing Place of Service denials for hospital imaging studies from CIGNA HealthSpring? If so, are you in-network or out of network with them?
We're seeing common studies like hospital chest xrays denied for this reason. I suspect it's a system error on their side, but it could be some kind of effort to drive imaging out of the hospital. I'm pretty sure Medicare Advantage plans are required to cover on at least the same basis as traditional Medicare, so this doesn't seem legit.
We have a CIGNA commercial contract (which probably pre-dates the advent of their MA product), and HealthSpring has never been a problem up until now. With these denials, we get a letter saying that because we're out of network, we have to waive our right to bill the patient if we lose in order to file an appeal, which also doesn't seem right in a case like this. This leads me to question whether this is an issue for in-network providers.
If anyone has figured out a way to tackle this, I would like to hear about it. I have reached out to our local Cigna network management person, and if that doesn't work I will try CMS.
Thanks in advance for any insight.
Dave
David Smith, FACMPE | Executive Director | 785.393.8387
5800 Foxridge Dr. Ste 240 | Mission, KS 66202 | www.uickc.com
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