April 5, 2024
With health care costs continuing to rise, it’s more important than ever to be conscious of how much your patients are paying for the care they receive. You have the direct ability to improve the quality and financial value of the services your Cigna patients receive – through your care and the referral choices you make.
If you must refer a patient to another dental provider, it is important to make sure that the provider participates in the patient’s Cigna Dental network. Your patient’s out-of-pocket costs may be increased if the provider is not in network. And, in some cases, it could result in your patient not having coverage for services rendered by an out-of-network provider. If you would like to refer an out-of-network specialist to join Cigna Dental, please see below for “Refer a specialist to our network.”
Referral requirements by network
The table below highlights referral requirements and procedures for each Cigna Dental network. However, it is highly recommended that you refer to the Cigna Dental Office Reference Guide applicable to the network you participate in and your specialty. To access the guides, log in to CignaforHCP.com > Resources > Reference Guides > Dental Office Reference Guides.
| Cigna Dental Care® (DHMO) specialty referrals | Cigna Dental Care® (DHMO) network general dentists are expected to render the range of services that are required for graduation from dental school, including root canal therapy, some extractions, treatment of gingivitis and early periodontitis and pediatric dentistry. Referrals must be made to network specialists and must be consistent with a complete treatment plan that you develop and communicate to the member.
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| DPPO referrals | Although most Cigna Dental PPO plans have an out-of-network option, the use of network dentists usually results in cost savings for Cigna customers. Cigna Dental PPO Advantage and Cigna Dental PPO plans do not need prior approval for referrals to a specialty dentist. By choosing an out-of-network specialist, the Cigna customer’s financial responsibility may be higher as a result of this selection. Please consult the plan documents or call the claim office for specific information. To recommend a specialist within the Cigna Dental PPO Networks, please call Cigna Customer Service at 800.Cigna24 (800.244.6224) or visit Cigna.com for a listing. |
Refer a specialist to our network
If you have a good relationship with an out-of-network specialist and often refer patients to them, consider referring them to Cigna Dental. As appropriate, we will consider your referral and contact the provider with network offerings*.
To refer a specialist to the Cigna Dental PPO or Cigna Dental Care (DHMO) networks, please call the National Contracting Unit at 800.280.9622 or email your nomination to DentistEnrollment@Cigna.com. Email nominations should include your name, the specialist’s full name, specialty, address, city, state, zip code, and telephone number. Specialists are also welcome to contact our National Contracting Unit directly.
*Submitting a specialist referral to Cigna Dental does not guarantee that the specialist will be added to the network. We will do our best to expand our provider networks utilizing your suggestion as appropriate.
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