CignaCommercial Clinical Policy

Cigna Non-Participating Laboratory Services - (A001) Form


Non-Participating Laboratory Services associated with an emergency service visit

Indications

(478752) Is the laboratory service associated with a true emergency service visit? 

Non-Participating Laboratory Services under federal or state law requirements

Indications

(478753) Does federal or state law require that the laboratory service be paid at the in-network benefit level? 

Non-Participating Laboratory Services not available from participating labs but are Covered Services

Notes: Services will be reviewed to determine if Cigna's Network Adequacy Policy applies.

Indications

(478754) Are the laboratory and pathology services not available from a participating laboratory and considered Covered Services (medically necessary and a covered benefit)? 

Effective Date

01/15/2023

Last Reviewed

NA

Original Document

  Reference



Definitions

A001 Participating: Any doctor, hospital, clinic or laboratory† contracted with Cigna to provide health care services.

Non-participating: Any doctor, hospital, clinic or laboratory not contracted with Cigna to provide health care services.

In-network benefit level: Coverage level applied when care is provided to a Cigna customer by a doctor, hospital, clinic, or laboratory that is contracted with Cigna to provide health care services.

Out-of-network benefit level: Coverage level applied when care is provided to a Cigna customer by a doctor, hospital, clinic, or laboratory that is not contracted with Cigna to provide health care services and that does not participate in the network associated with the customer’s Cigna plan.

†Note: For a list of participating laboratories in your area, go to myCigna.com and search for participating laboratories in the health care professional directory. Or, call Cigna Customer Service at 1.800.244.6224. “Cigna Companies” refers to operating subsidiaries of Cigna Corporation. All products and services are provided exclusively by or through such operating subsidiaries, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. © 2023 Cigna.