CCN OAP front cover - CHG Healthcare Services

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Health Care Professional Compensation 9 Health Care Professional Compensation CIGNA is committed to keeping you informed about matters related to your health care plan. For that reason, we offer the following description of the way that CIGNA compensates health care professionals (physicians, hospitals and other health care practitioners and facilities) that participate in our networks. CIGNA compensates health care professionals in ways that are intended to emphasize preventive care, promote quality care and ensure the appropriate and cost-effective use of covered medical services and supplies. CIGNA reinforces this philosophy through utilization management decisions made by its medical directors and medical management staff. CIGNA employees are encouraged to promote appropriate utilization of covered health care services and to discourage underutilization. The methods by which participating health care professionals agree to be compensated are described generally here. The amount and type of compensation a health care professional agrees to accept may vary depending upon the type of plan. For example, a hospital may agree to accept less for services provided to patients enrolled in an HMO plan than to patients enrolled in other types of plans. In addition, CIGNA may attempt in various ways to promote the use of participating health care professionals based upon quality and cost-effectiveness measures while assuring quality and access to covered services and supplies. DISCOUNTED FEE FOR SERVICE: Payment for services is based on an agreed-upon discounted amount from the health care professional’s bill. CAPITATION: By mutual agreement, network physicians, physician/hospital organizations (PHOs) or other health care professional groups are paid a fixed amount (capitation) at regular intervals for each individual assigned to the physician, PHO or other health care professional groups, whether or not services are provided. This payment covers physician and/or, where applicable, hospital or other services covered under the benefits plan. Health care professional groups and PHOs may in turn compensate health care professionals using a variety of methods. Capitation can offer health care professionals a predictable income, encourage physicians to keep people well through preventive care, eliminate the financial incentive to provide services that will not benefit the patient and reduce paperwork. CIGNA may also work with third parties that provide network management services. Under these arrangements, CIGNA pays the third party a fixed monthly amount per individual for these services. Health care professionals are compensated by the third party for services provided to CIGNA plan participants from the fixed amount. Compensation arrangements are agreed upon by the third parties and their contracted health care professionals, and may include discounted fee for service and capitation. Some health care professionals and third parties that provide network management services may participate in a risk-sharing arrangement with CIGNA; they agree on a target amount for the cost of certain services and share all or some of the amount by which costs are over or under the target. Services are monitored using criteria that may include accessibility, quality of care, customer satisfaction and appropriate and cost-effective use of medical services and supplies. SALARY: Physicians and other health care professionals who are employed to work in CIGNA's Arizona staff-model medical facility are paid a salary. The salary is decided in advance each year and is guaranteed regardless of the services provided. Physicians are eligible for a bonus at the end of the year based on performance, which is evaluated using criteria that may include quality of care, quality of service and appropriate and cost-effective use of medical services and supplies. BONUSES AND INCENTIVES: Some health care professionals may receive additional payments based on their performance, which is measured using criteria that may include quality of care, quality of service and appropriate and cost-effective use of medical services and supplies. Health care professionals may also receive financial and/or nonfinancial incentives that promote utilization of cost-effective participating health care professionals (such as hospitals, labs, specialists and vendors) and covered drugs and supplies. PER DIEM: A specific amount is paid to a hospital per day for all health care received. The per diem payment may vary by type of service and length of stay and the payment may in some cases be greater than the hospital’s normal billed charges. CASE RATE: A specific amount is paid for all health care received in the hospital for a given hospital stay (such as for a normal maternity delivery). If you would like to find out which compensation method applies to services you receive from a health care professional, just ask the doctor’s administrative staff. CIGNA Customer Service is available to help with general questions at the toll-free telephone number on your CIGNA ID card.
10 Service Area Service Area Participating health care providers are located throughout the service area. Look under specific listings in this directory for the addresses of physicians and hospitals that participate in this network.
Page 1 and 2: Open Access Plus Open Access Plus I
Page 4 and 5: Introduction 3 Introduction WHO WE
Page 6 and 7: Introduction 5 TRANSITIONAL CARE Th
Page 8 and 9: CIGNA LifeSOURCE Transplant Network
Page 12 and 13: How to Read the Physician Listing H
Page 14 and 15: Primary Care Physicians Fairfield C
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Primary Care Physicians New London
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Obstetricians/Gynecologists Fairfie
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Pharmacies 309 Pharmacies If you ha
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Vision Care Vision Care If you have
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Other Services 313 Select Physical
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Other Services 315 Visiting Nurse A
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Other Services 317 Housatonic Valle
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Other Services 319 Women’s Center
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Index 321 Augeri, Francine M., MSN,
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Index 323 Calderon, Stephen F., MD
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Index 325 Defigueiredo, John M., MD
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Index 327 Friedman, Lloyd N., MD...
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Index 329 Herzog, Andrew R., MD ...
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Index 331 Kope, Walter R., MD......
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Index 333 Marcus-Cohen, Lynn M MSW
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Index 335 Nottidge, Michael, MD ...
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Index 337 Rappaport, Marc G., DO...
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Index 339 Shannon, Amy R MSN ARNP .
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Index 341 Topal, Jeffrey E., MD ...
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Index 343 Zuckerman, Bernard D., MD
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‘‘Cigna", "Cigna HealthCare’
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CCN OAP front cover - CHG Healthcare Services

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