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Changes in Acupuncture Benefits Under the Cigna Plan

Young man getting acupuncture treatment, closeup

Changes to the in- and out-of-Network acupuncture benefits under the Cigna Plan:

Effective March 1, 2017, the copayment required for in-network acupuncture visits was reduced from $25 to $15 per visit. With this improvement, acupuncture copays are now the same as copays for physical therapy and chiropractic visits, which have been in place for the past several years.  This enhancement to in-network acupuncture benefits is part of a comprehensive effort to address rising costs and help Cigna grow its network of acupuncture providers.

In conjunction with the copay reduction, Equity-League has asked Cigna to vigorously recruit more acupuncture providers for its network – in particular those providers who treat our participants in high volumes. At the same time, effective May 1, 2017, the Health Plan has reduced reimbursements to out-of-network providers to roughly the same level Cigna pays its network providers. This important change makes it less attractive to a provider to remain outside of Cigna’s network. In addition, your out-of-pocket costs owed to your out-network provider might increase.

What led the Health Plan to enact these changes?

The answer is two-fold: rising (and accelerating) costs and high utilization of non-network providers for acupuncture services.

While the rate of inflation in the overall economy has been relatively low in recent years, health care costs have continued to rise substantially. In the most recent Plan Year alone, the Health Fund saw a  6.5% increase in costs per participant from the previous year. Though this overall trend is concerning, costs have risen much more dramatically for our participants’ acupuncture care – these costs have increased more than 75% between 2013 and 2015. An analysis of current trends suggests that these increases are accelerating, especially among out-of-network providers.

Additionally, while more than 80% of Health Plan participants’ overall medical claims are from Cigna in-network providers, more than 80% of Plan participants’ acupuncture care is from out-of-network providers. This has led to costs that are many times higher than they are for most health plans, and continue to increase at a faster rate. Only a portion of the higher costs can be explained by the high level of physical activity common to our Fund participants, such as dancers.

The Health Fund’s Trustees recognize that many participants find acupuncture treatments to be essential, especially those who perform highly physical roles. Therefore, to balance out the need to hold down costs, (for the benefit of all participants) with the need to provide quality, comprehensive benefits, the Trustees enacted the in-network benefit improvement and asked Fund Office staff to open the dialogue with Cigna about its network of acupuncture providers.

How can you help?

If you currently receive acupuncture care from an out-of-network provider, please ask your provider to consider joining the Cigna network. If he or she joins, costs will be reduced both for you and the Health Plan. If you provider shows interest in joining the network, please call the Fund Office at (212) 869-9380 (New York City area) or at (800) 344-5220 (toll-free nationwide), to let us know and we will ask Cigna to get in touch with your provider.

We at the Fund are committed to helping Cigna grow its network of acupuncture providers so that all participants of the Equity-League Health Plan can benefit from the savings.

Sincerely,

Equity-League Health Benefit Fund