The Division of Personnel’s Group Health Insurance Unit, the GESC Board and Cigna inform all active employees and retirees under the age of 65 about the precertification process that is required before any high-tech imaging is conducted. Once approved, this information is useful and will make planning for procedures much easier.
Precertification is a review process that determines whether a procedure, treatment or service is medically appropriate. High-tech imaging, such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, requires precertification. For certain plan types, precertification for high-tech imaging will direct you to a specific site of care in a patient’s area. Cigna, however, has this process in place to help protect people from unnecessary cost, unnecessary radiation exposure or surprise bills.
Here’s how it works:
You and your in-network Cigna provider decide you need a CT, MRI or PET scan. Then, your in-network provider will send in your precertification request and must complete the specific information pertaining to your health case to complete the review. Note that if a Government of the Virgin Islands (GVI) employee or retiree under the age of 65 decides to use a provider who is out of the Cigna Network, he or she will be responsible for the cost.
(A) If you are approved, then both you and your in-network provider will be notified, and then you will schedule an appointment and compare the cost that best fits your financial situation.
(B) If you are not approved, then both you and your in-network provider will be notified. You will have the following options: (1) consider alternatives and contact your provider for options or (2) discuss or appeal your reason of denial. In this case your provider may speak with Cigna’s medical director.
Note that once the provider has completed the necessary paperwork, a routine review takes about five business days to complete. Once a decision is made (approved or denied), a letter will be sent with the details of the decision.
For more information, visit www.myCigna.com.