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CIGNA Cost of Care Estimator ®

What is the CIGNA Cost of Care Estimator?

The Estimator is an online tool that enables you to create an estimate of your patient's payment responsibility for specific medical services based on a real-time snapshot of their CIGNA administered medical benefits. The Estimator accurately predicts the actual cost to patients within +/- 10% nearly 90% of the time when the estimate is generated.

There are two easy ways to access the Estimator once you are logged in to the CIGNA for Health Care Professionals website (www.cignaforhcp.com):

  • Click Estimate Patient Liability to search for your patient and create an estimate, or
  • Click Verify Eligibility and Benefits to search for your patient. While you are reviewing the patient's eligibility and benefits, click Estimate Costs' to create an estimate.

The estimate is highly personalized and specific to the:

  • Health care professional generating the estimate
  • Treatment or service
  • Patient's CIGNA administered medical benefits (based on a real-time snapshot)

The resulting Explanation of Estimate allows you and your patient to see the:

  • Total cost of the service or treatment
  • Anticipated amount the CIGNA administered plan will pay
  • Patient's out-of-pocket cost
  • Anticipated payment from the patient's health account (i.e., HSA, HRA, FSA) when automatic claim forwarding is enabled*

Why use the CIGNA Cost of Care Estimator?

The Estimator helps your patients in CIGNA administered medical plans understand what the total cost of treatment will be, what the plan will pay, and whether they will owe anything out of pocket. The Estimator also provides a way to discuss payment options with your patient.

The printed Explanation of Estimate helps educate your patients about how their medical benefits influence what they can expect to owe, and validates the estimated amount based on their medical benefits.

When can you use the CIGNA Cost of Care Estimator?

  • The Estimator can be used for your patients in these CIGNA administered medical plans+:
    • Preferred Provider Organization (PPO)
    • Exclusive Provider Organization (EPO)
    • Open Access Plus (OAP) and Open Access Plus In-Network (OAPIN)
    • New! Managed care plans (HMO, Network-EPP, HMO Open Access, Network Open Access, HMO POS-Flex, Network POS-DPP, HMO POS Open Access, Network POS Open Access)
    • Patients with Choice Fund plans
  • Estimates can be generated pre-care (e.g., at scheduling) or while a patient is in the office (before check in or at check out)
  • The Estimator is available in all care settings (e.g., outpatient, facility, specialty, etc.)

For more information, refer to the CIGNA Cost of Care Estimator FAQs, or access our CIGNA Cost of Care Estimator eCourse.



*Patients in CIGNA administered Choice Fund PPO, OAP and OAPIN plans can choose to have their out-of-pocket costs paid directly out of their health care spending account(s). After claim processing, if funds are available, CIGNA automatically sends payment to you on behalf of the patient's health account, usually along with CIGNA's portion of the payment.

+Estimates are NOT currently available for patients covered by the following CIGNA plans or networks:

  • Shared Administration (Taft-Hartley)
  • Plans associated with GWH-CIGNA network
  • Starbridge or Fundamental Care plans


     

The CIGNA Cost of Care Estimator helps facilitate a financial discussion between you and your patient prior to care so expectations for financial responsibility are appropriately set.