Continuity of Care Service Requests - (UM-41)

Cigna will continue to reimburse terminating in‑network or non‑participating providers/facilities at in‑network levels for limited continuity-of-care situations (terminal illness, active acute/chronic treatment, pregnancy including postpartum, hospital confinement, scheduled non‑elective surgery, and other serious/complex conditions), typically up to 90 days with many state-specific deviations and subject to plan benefit limits and exclusions (e.g., professional‑review terminations). Requests must be submitted on a Continuity of Care Request Form with eligibility verification and clinical documentation (brief history, treatment plan/current evaluation) within the applicable timeframe (generally before or within 90 days of notice, though state rules vary), incomplete info is pended per the LOI policy, and Medical Director review is required for cases beyond nurse authority or for extensions.

"When a participating health care professional (may be physician, ancillary and/or facility) leaves the network and ongoing medical care/services are requested"