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- Cigna Responds to CAP’s Call for Clarity on Revised PC of CP Payment Policy
Following a request for additional details on its payment policy change, Cigna provided the CAP with further clarity on a revised policy for the professional component of clinical pathology (PC of CP) when billed by pathologists. The CAP asked Cigna for additional details on October 26 after the insurer acknowledged the role of pathologists in providing laboratory management and oversight services.
In a November 12 letter to the CAP, Cigna explained that individual pathologists should submit claims for the PC of CP, and if “the facility … has already received payment for the service through their contract with Cigna,” they will be notified in the form of a denial through Cigna’s claim system. At that point, the pathologist should communicate with their facility (see pages 6-7 of the CAP’s PC Billing Information Package) to determine whether payment for these services were in fact received from Cigna by the facility and, if the denial was made in error, then “this denial carries with it a right to appeal.”
In the CAP’s letter to Cigna on October 26, the CAP had requested clarification on how Cigna proposes operationalizing its policy and ensuring pathologists receive appropriate payment for these services. The CAP has opposed policies to deny payment and has urged the insurer to continue paying for the PC of CP services for all pathologists. In a CAP letter to Cigna on April 23, the CAP argued that discontinuing reimbursement for these services would prove detrimental to patients, and to the integrated delivery of care to which laboratory diagnostic services are central. After successfully stopping Cigna from implementing the original policy, Cigna acknowledged the “payment for the service” and revised the policy as outlined above.
The CAP remains engaged on this issue and will continue advocating for appropriate payment for the PC of CP. View the CAP’s Private Sector Webpage for more information.