TMA believes a Cigna referral policy imposes a red-tape hassle on physicians and patients and will ask the Texas Department of Insurance (TDI) to determine if the company has violated the agency's network adequacy rules.
Cigna requires physicians and patients to sign a form whenever the physicians refer patients to a non-Cigna network physician or other provider. Physicians must explain on the form why they recommend out-of-network services, must disclose whether they have a financial relationship with the other provider, and must obtain the patient's consent to the referral by having the patient check a box and sign the form. Physicians aren't required to send the forms anywhere but must keep them on file indefinitely.
TMA notified Cigna of its opposition to the requirement two years ago, before TDI adopted network adequacy rules. Earlier this year, TDI granted insurers permission to include contract provisions that require certain disclosures about out-of-network referrals. The rules say insurers can require referring physicians and other health care professionals to disclose ownership interests in facilities or whether the referral is to a person or facility that "might not be a preferred provider."
TMA questions the overly broad approach Cigna is taking on out-of-network referrals and the new rules. The TMA Council on Socioeconomics and the TMA House of Delegates adopted policy opposing such forms and the intrusion into the patient-physician relationship they represent, said Lee Spangler, TMA's vice president for medicine economics.
Action, July 1, 2013