Improved In-Network Physical Therapy and Chiropractic Benefits
Chiropractic and Physical Therapy Changes - Effective January 1, 2010
"While the knee jerk" reaction to high therapy and chiropractic costs is often to reduce benefits, the Trustees took a much more balanced approach. First, noting the poor utilization of network therapy and chiropractic providers, they have requested that CIGNA make vigorous efforts to recruit more Physical Therapy and Chiropractic Providers into their network, particularly the providers who treat our participants in high volumes. And this is an area where the Fund can use your help. If you currently obtain these services through an out-of-network provider, please ask your provider to consider joining the CIGNA network. If they do, costs will be reduced for both you and the Fund. If your provider has any interest, please contact the Fund Office and we will ask the CIGNA Provider's Relation Department to get in touch with your provider. Although adding a provider to a network takes time, in many cases it can be accomplished.
Second, the Trustees actually reduced co-pays for in-network Physical Therapy and Chiropractic providers from $25 to $15 in hopes of encouraging members to use in-network benefits, even if doing so means changing a provider. On the other hand, allowable amounts for services incurred by out-of-network providers have been reduced to approximately the same level as those for in-network providers. This will mean that in many cases, if you use an out-of-network provider, your responsibility for costs will increase. This increase may be quite substantial in certain cases. Please remember that the Fund generally reimburses 70% of the cost of out-of-network providers once the annual deductible has been met, but only up to the allowable charge for that procedure. Any remaining balance above the Fund’s allowable charge is your responsibility in full. So if your provider charges $100 for a given procedure, and CIGNA’s allowance for that procedure is only $80 (assuming the deductible has been satisfied), CIGNA will pay 70% of the $80 (or $56) and you will be responsible for the other 30% (or $24) plus the amount above $80 (or $20, for a total of $44). Therefore, if you use an out-of-network provider, we urge you to find out before you begin services what the provider will charge for those services and compare that with what CIGNA will allow (which you can find out by calling CIGNA with the provider’s charge CIGNA will tell you whether that charge exceeds their allowance and if so by how much).
It is hoped that this combination of initiatives will rein in the high cost of care in these areas while actually enabling plan participants to enjoy better benefits by utilizing network providers.
For questions regarding these changes, please contact the Health Department within the Fund Office and a customer service representative can assist you".