Important Alert Regarding Cigna Insurance Coverage
** This information is not meant to persuade you into making any changes to your relationship with SMH or with any insurance company under which you are currently enrolled.
At Sarasota Memorial Hospital (SMH), our highest priority is ensuring our community has access to affordable, high quality, comprehensive medical care. As the region’s only not-for-profit hospital, we are proud of our consistently high rankings among America’s top hospitals and our commitment to provide vital mission services that other local hospitals do not — including a life-saving trauma center, critical care nursery, pediatrics, maternity and more — at charges below our surrounding, for-profit hospitals.
Negotiating fair contract terms and reimbursement rates with insurance companies every few years is standard practice for medical providers and is essential to providing high-quality services in the future.
Our current agreement with Cigna expires Oct.15, 2019. If we cannot reach mutually acceptable terms to continue our agreement with Cigna by that date, our hospital and network of outpatient and urgent care centers, as well as First Physicians Group of Sarasota Memorial (FPG), will become out-of-network providers for Cigna members until a new agreement can be reached.
We know that Cigna members have concerns. We hope the information on this page will help answer the most frequently asked questions.
If you would like Sarasota Memorial to remain in Cigna’s approved network of providers, we encourage you to call or write the insurer about this change. Let them know how you have been affected and how important it is that SMH remains part of your “in-network” coverage.
You can contact Cigna:
You can contact Cigna Member Services at (800) 997-1654 or the number on your Cigna ID card.
On Social Media
By USPS Mail
Cigna Corporate Headquarters
900 Cottage Grove Road
Bloomfield, CT 06002
Frequently Asked Questions
Which Cigna plans and SMH services are affected?
The pending change will affect members of Cigna’s commercial/employer group plans. When the contract expires, all Sarasota Memorial hospital and outpatient services (except for behavioral health services) will become out-of-network providers. Sarasota Memorial’s First Physicians Group also will become out-of-network providers.
The pending change does NOT affect:
- SMH behavioral health services
- Patients with traditional Medicare and Medicare Supplemental plans. It also will not affect Cigna’s Medicare Advantage plans (offered through HealthSpring) because they are not marketed in this area and not included in our current agreement.
What happens in emergency situations?
In emergency situations, you should always go to the nearest ER – no prior authorization is needed, and a patient’s financial responsibility is typically no higher if they go to an out-of-network emergency room. Except in rare circumstances, emergency services and care provided by SMH should be covered for Cigna members receiving emergency and trauma services at Sarasota Memorial's main ER and freestanding ER in North Port at in-network rates. Cigna members will be liable to pay their patient responsibility amounts under their plan.
What if I’m pregnant? Or need continuing care for an illness or injury?
There are provisions in state law to ensure continuing care at in-network rates for women who are pregnant and for patients in the midst of treatment for certain medical conditions, such as cancer. Although there are limitations, we will do everything we can to ensure continuity of care for those who are eligible. Unfortunately, women and children who do not qualify for continuing care benefits likely will be required by Cigna to seek hospital care in another community since Sarasota Memorial is the only hospital in Sarasota County with maternity, inpatient pediatrics and neonatal intensive care services.
Will this affect my relationship with my First Physicians Group doctor?
Yes. First Physicians Group (FPG) is owned by Sarasota Memorial and FPG’s contract with Cigna also is set to expire October 15, 2019. Until SMH and FPG reach an agreement with Cigna, services provided by your doctor at Sarasota Memorial or its network of outpatient centers (including laboratory, imaging, pain care, rehabilitation and urgent care centers) will be subject to higher out-of-pocket costs, unless Cigna specifically agrees to cover the care at in-network rates.
How serious is this dispute? Could it be resolved in the coming days?
It is normal business practice for hospitals and health insurers to renegotiate and renew insurance contracts every few years in order to reflect increasing healthcare costs, changes in government reimbursement and improvements in technologies and care. As a community-owned hospital, SMH values and carefully considers its relationships with health insurers. While we remain in active contract renewal discussions with Cigna, there is no guarantee that we will be able to reach an agreement.
Is there anything I can do to change Cigna’s decision?
Cigna members can let the insurer know how important it is that SMH be in its approved network. Plan members can call the phone number on the back of their insurance card or refer to the contact information listed above.
You also have the right to receive care from another hospital or provider. Contact your insurer (the telephone number on your insurance card) directly about your choices. If a change becomes necessary, we will work with you to ensure a smooth transition of care.
Sarasota Memorial Billing Advocacy Office: If you have questions about how this might impact your ability to seek care at Sarasota Memorial Hospital or our outpatient and urgent care centers, call SMH’s Billing Advocacy Office at 941-917-1540 or 1-800-764-2455, weekdays 8 a.m.-5 p.m.
First Physicians Group: If you have questions about how this might impact care provided by your FPG physician, contact FPG’s central office at 941-917-2600, weekdays 8:30 a.m.-5 p.m.
Medicare-eligible Patients: SMH does not currently have a contract with Cigna’s Medicare Advantage plan (offered through HealthSpring). To learn more about Medicare plan options by calling or meeting one-on-one with volunteer counselors with the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) program. SHINE services are free, unbiased and confidential. Call the Florida Elder Helpline at 1-800-963-5337, or visit floridashine.org.