CIGNA HEALTHCARE OF TENNESSEE Important plan information for

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CIGNA LIFESOURCE Transplant Network Alabama University of Alabama at Birmingham Medical Center Arizona Banner Good Samaritan Medical Center Good Samaritan City of Hope Mayo Clinic Scottsdale University of Arizona Health Sciences California California Pacific Medical Center Cedars-Sinai Medical Center Children’s Hospital Los Angeles City of Hope National Medical Center Loma Linda University Medical Center Lucile Salter Packard Children's Hospital Scripps Green Hospital Sharp Memorial Hospital Stanford University Medical Center UCLA Medical Center UCSF Medical Center UC Davis Medical Center USC University Hospital Colorado Children’s Hospital of Denver Presbyterian St. Luke's Medical Center University of Colorado Hospital Connecticut Yale-New Haven Hospital Florida All Children’s Hospital Florida Hospital H. Lee Moffitt Cancer Center Mayo Clinic Jacksonville Florida - (Cont.) Shands Hospital Tampa General Hospital University of Miami Jackson Memorial Hospital Georgia Children’s Healthcare of Atlanta at Egleston, Atlanta, Georgia Northside Hospital/The Blood and Marrow Transplant Group of Georgia Illinois Children’s Memorial Hospital University of Chicago Medical Center and Wyler Children's Hospital Indiana Clarian Health - Indiana University Hospital Clarian Health - Methodist Hospital Clarian Health - Riley Children's Hospital Kansas Children’s Mercy Hospital Kentucky Jewish Hospital Maryland Johns Hopkins Health System University of Maryland Medical Center Massachusetts Lahey Clinic Medical Center Tufts - New England Medical Center University of Massachusetts Medical Center Minnesota Mayo Clinic Rochester Missouri Barnes Jewish Hospital Children’s Mercy Hospital St. Louis Children's Hospital Nebraska The Nebraska Medical Center New Jersey Hackensack University Medical Center Robert Wood Johnson University Hospital St. Barnabas Medical Center New York Mt. Sinai Medical Center New York University Medical Center North Carolina Duke University Medical Center University of North Carolina Hospitals Ohio Children's Hospital Medical Center Cleveland Clinic Foundation Columbus Children’s Hospital University Hospitals of Cleveland Oregon Legacy Good Samaritan Hospital and Medical Center Oregon Health & Science University Pennsylvania Children’s Hospital of Pittsburgh Temple University Health System Thomas Jefferson University Hospital University of Pennsylvania Health System UPMC Presbyterian Shadyside Hospital South Carolina Medical University of South Carolina Tennessee Methodist University Hospital St. Jude Children’s Research Hospital Vanderbilt University Medical Center Texas Cook Children's Medical Center Medical City Dallas Hospital Memorial Hermann Hospital Texas Children's Hospital Texas Transplant Institute The Methodist Hospital University of Texas MD Anderson Cancer Center University of Texas Southwestern St. Paul Hospital Virginia Medical College of Virginia Hospitals University of Virginia Hospital Wisconsin Children's Hospital of Wisconsin Froedtert Hospital St. Luke’s Medical Center 7
8 Precertification Precertification Our goal is to help make sure that you have access to the appropriate care, in the appropriate setting. We have established a wide network of physicians and we continuously contract with new physicians to help make sure that you have access to care from credentialed providers. Your plan may require that you choose a Primary Care Physician (PCP) for yourself and your covered dependents. Your PCP is your personal doctor who can coordinate your medical care and keep your medical history. If your plan does not require you to choose a PCP, you can still choose a PCP or a personal physician for yourself and your covered dependents to help coordinate your care. Your first stop should be your PCP or personal physician. He or she can help determine if you need specialty care or hospitalization. WHAT IS PRECERTIFICATION? Precertification is a review process where CIGNA HealthCare nurses, pharmacists and/or physicians work with your physician to determine: ■ Whether a procedure, treatment or service is a covered benefit. ■ What your benefits will be for a procedure, treatment or service if you use a provider who is not in the CIGNA HealthCare network. HOW DOES THE PROCESS WORK? Your plan may require precertification for hospital admissions and selected outpatient services. When precertification is required, a CIGNA HealthCare nurse evaluates the request using nationally recognized guidelines. These guidelines are consistent with sound clinical principles and processes and have been developed with involvement from actively practicing health care providers. CIGNA HealthCare nurses determine what services are covered based on your plan benefits and using these guidelines. When guidelines do not exist, clinical resource tools based on clinical evidence are used. Anytime a CIGNA HealthCare nurse is unable to approve coverage for clinical reasons, the case is referred to a CIGNA HealthCare physician who considers each case on an individual basis. The CIGNA HealthCare physician may speak with your physician to obtain additional information. You and your physician will be notified in writing if a request for a precertification number cannot be approved based on the information we received and your plan benefits.
Page 1 and 2: CIGNA HEALTHCARE OF TENNESSEE Impor
Page 4 and 5: A Business of Caring. A Business of
Page 6 and 7: A Business of Caring. You’re cove
Page 10 and 11: Precertification WHEN DOES THE REVI
Page 12 and 13: Service Area Service Area The follo
Page 14 and 15: Primary Care Physicians Crittenden
Page 16 and 17: Primary Care Physicians Shelby Coun
Page 22 and 23: Obstetricians/Gynecologists Critten
Page 24 and 25: Obstetricians/Gynecologists Shelby
Page 26 and 27: Specialists De Soto County 7668 Air
Page 28 and 29: Specialists Shelby County 7865 Educ
Page 30 and 31: Specialists Shelby County Mallov, J
Page 32 and 33: Specialists Shelby County Ballouk,
Page 34 and 35: Specialists Shelby County Litch, Me
Page 36 and 37: Specialists Shelby County PEDIATRIC
Page 38 and 39: Specialists Shelby County Silva, Ed
Page 40 and 41: Specialists Shelby County 1458 W Po
Page 42 and 43: Hospitals Hospitals Arkansas CRITTE
Page 44 and 45: Vision Care Providers Vision Care P
Page 46 and 47: Other Services HealthSouth North Me
Page 48 and 49: Index G Gaber, Osama A., MD .......
Page 50 and 51: Index Wang, Haiqui E., MD .........
Page 52 and 53: Notes
Page 58:
‘‘CIGNA or CIGNA HealthCare’
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CIGNA HEALTHCARE OF TENNESSEE Important plan information for

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