COVID-19 Update: Sarasota Memorial / First Physicians Group has not extended its contract with Cigna, which expired April 30. In most situations, state law requires insurance plans to pay for emergency services and care, whether the facility has a network provider agreement or not. If you are concerned about your healthcare options during the COVID-19 crisis, we encourage you to call Cigna to discuss any changes they are making to help members through this critical time. Many major insurers are making exceptions to policies & claims processes for patients with COVID-19 and those suspected of having it.
Important Alert Regarding Cigna Health Insurance Network Coverage
Sarasota Memorial and First Physicians Group have regarded Cigna as a partner in caring for our community for decades. In recent years, however, we have seen greatly reduced levels of coverage for many patients using the Cigna network and the denial of claims that should have been paid.
For more than a year, we have tried to work with Cigna on a new contract that protects our patients from coverage decisions that impact their ability to access care and from unjustified claim denials. We have given Cigna ample time and several contract extensions, but the company refuses to consider these standard provisions, which are included in our agreements with other major insurance partners.
Our current agreement with Cigna terminated April 30, 2020. We are now focused on providing Cigna network members with information that will help them plan for their future medical needs. We understand Cigna network members may have questions and concerns. Below, you will find information and additional contacts to help guide you through this transition.
Frequently Asked Questions
Which Cigna plans and SMH services are affected?
As of May 1, 2020, Sarasota Memorial Hospital and its network of outpatient and urgent care centers, as well as First Physicians Group of Sarasota Memorial (FPG), are out-of-network providers for members of Cigna’s health insurance network, including commercial and employer health plans.
The pending change does NOT affect:
- Patients with traditional Medicare and Medicare Supplemental plans.
- Patients with Cigna’s Medicare Advantage plans (HealthSpring), which are not marketed in this area and are not included in our current agreement.
What happens in an emergency?
In emergency situations, you should always go to the nearest ER. Cigna members can still access care in SMH’s Emergency Care Center or freestanding ER in North Port, whether the facility has a network provider agreement or not. According to Florida law, HMO plans, licensed PPO plans and certain other plans generally have an obligation to pay for covered emergency services and care.
What if I’m pregnant? Or need continuing care for an illness or injury?
People undergoing active treatment that should not be interrupted or delayed, such as chemotherapy or hospitalization at Sarasota Memorial Hospital, and Cigna network members in their second or third trimester of pregnancy can request authorization from Cigna to receive continuing care from SMH and First Physicians Group at in-network coverage levels. Cigna makes the determination on who qualifies, but Sarasota Memorial and First Physicians Group providers stand ready to help patients apply for continuing care.
According to Cigna, Continuity of Care forms must be submitted to the company within 30 days of the April 30, 2020 contract termination date. Click here for more information and to access "Transition of Care / Continuity of Care" applications on Cigna's website.
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 terminated April 30, 2020. Services provided by your doctor at Sarasota Memorial or at any of our outpatient centers (including laboratory, imaging, pain care, rehabilitation and urgent care centers) now will be subject to higher out-of-pocket costs.
Are there discounts for self-pay patients?
Yes. Cigna members who choose to self-pay for services rather than having the insurer billed can request a self-pay discount. FPG patients are eligible for a 30% discount, while patients seeking care at SMH or its outpatient and urgent care centers are eligible for a 60% discount. Self-pay discounts are typically given when patients pay their bill in full upfront or at the time of service.
Will there be another extension?
No. We have given Cigna ample time and several extensions to work with us on a new contract, but the insurer refused to agree to standard provisions that protect patients and the health system from coverage decisions that impact members’ ability to access care and from unjustified claim denials. These basic protections are included in our contracts with other major insurance partners.
Is there anything I can do to change this decision?
At Sarasota Memorial, our highest priority is ensuring our community has access to affordable, high quality, comprehensive medical care. We cannot change the rules for one company and agree to a contract that lacks basic protections for our patients and health system.
Please reach out to the offices below to connect with representatives from SMH, FPG and Cigna who can help guide you through this transition. If a change in provider 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 800-764-2455, weekdays 8 am-5 pm.
First Physicians Group: If you have questions about how this might impact care provided by your FPG physician, contact FPG’s billing office at 941-917-2600, weekdays 8:30 am-5 pm.
Cigna: Contact your insurer (the telephone number on your Cigna ID card) directly about your choices, or call Cigna Member Services at 800-997-1654.
Health Insurances Accepted as of May 1, 2020
Click here for information about insurance plans that will be accepted by Sarasota Memorial Hospital and its network of outpatient facilities as of May 1, 2020.
Click here for information about insurance plans accepted by First Physicians Group as of May 1, 2020.
This is not a solicitation. This information is intended to help patients make informed decisions about their health and well-being and to update previous communications from Sarasota Memorial and First Physicians Group.