Vitamin D Testing Cigna Insurance July 2018 Vitamin

Vitamin D Testing Cigna Insurance July 2018

Vitamin D Coverage for Cigna Patients Vitamin D testing may not be covered for all patients with Cigna Insurance. Effective July 15, 2018, Cigna will cover Vitamin D testing as medically necessary for the following cases: Known osteoporosis Known condition that impacts the ability of the body to use available Vitamin D (including Vitamin D deficiency, malabsorption syndromes, and medications or disorders that affect the metabolism of Vitamin D and phosphate (e. g. , glucocorticoids, chronic kidney disease)) Clinical concerns of Vitamin D intoxication CONFIDENTIAL – For internal circulation only

Vitamin D CPT Codes that Affected Cigna Patients Vitamin D testing may not be covered for all patients with Cigna insurance CPT Codes affected under this policy update include: Vitamin D testing for other indications, including screening in the general population, is considered by Cigna to be not medically necessary. See the Cigna Coverage Policy, available at Cignafor. HCP. com (under Coverage Policy 0526). Cigna will not accept ICD-10 Code Z 00. 00 as a covered code for Vitamin D testing. Covered ICD-10 codes, as outlined in the December 2017 Policy Update letter sent to clients (cited Vitamin D Testing 0526), are summarized in a PDF, Cigna. Vitamin. D 020518 -Final. PDF, available under the resources link in the upper right-hand corner. CONFIDENTIAL – For internal circulation only

Vitamin D Coverage for Cigna Patients Vitamin D testing may not be covered for all patients with Cigna insurance Your role is to: Explain to the patient that their Vitamin D test may not be covered by Cigna. Ask the patient to sign the AWN (Advance Written Notice). Verify that the AWN is filled out completely with patient name, signature, and date. CONFIDENTIAL – For internal circulation only Cigna recently published a coverage policy for Vitamin D testing and, in some circumstances, will no longer cover Vitamin D testing.

Vitamin D Age Range Coverage for Cigna Patients Vitamin D testing may not be covered for all patients with Cigna insurance Note: This policy update only affects those individuals between the ages of 18 – 64, and does not impact coverage for patients under 18 or over 64. 0 -6 7 -11 12 -17 No impact on coverage CONFIDENTIAL – For internal circulation only 18 -39 40 -64 Must sign an AWN (Advance Written Notice) that their insurance may not pay for the Vitamin D testing 65 and older No impact on coverage

Vitamin D AWN Talking Points After saying, “Your doctor has ordered Vitamin D testing for you, ” it may be appropriate for you to add: Cigna recently published a coverage policy for Vitamin D testing and, in some circumstances, will no longer cover Vitamin D testing. Based on the diagnosis code provided by your doctor, Cigna will likely not cover this test for you. If the test is not covered, they will not pay for it. We will contact your doctor to make sure that he/she provided sufficient information and correctly ordered the test so that Cigna may pay for the test. If you would like to have the test today, even if it is likely not covered by Cigna, you can still do so, but you will be financially responsible if Cigna does not cover the test. CONFIDENTIAL – For internal circulation only

Vitamin D AWN Talking Points After saying, “Your doctor has ordered Vitamin D testing for you, ” it may be appropriate for you to add: In order to proceed, you can provide a credit card to pay for your portion of lab testing depending on your insurance coverage. It is required that you provide your written consent that you understand Cigna’s limited coverage policy and that you may have to pay for the cost of the testing that your doctor has ordered for you, if it is not covered by Cigna. We will bill Cigna for the testing and if the test is covered, we will only charge the card the amount of your copay, deductible, or coinsurance, if applicable. If the test is not covered, the charge to your card for the test will not exceed $241. 84, which is the cost of the test. CONFIDENTIAL – For internal circulation only The Talking Points document is available under the resources link

Vitamin D AWN Double-check to ensure we get paid It’s critical that the AWN contains the date, patient’s signature, and patient’s printed name on the AWN form. When a patient signs an AWN, we have documentation that the patient has been informed that their insurance carrier may not pay for the testing and agreed to be personally responsible to pay. HWM e. Labs functionality for AWN is similar to the ABN process for Medicare. CONFIDENTIAL – For internal circulation only

Vitamin D Coverage for Cigna Patients What if the patient refuses to sign the AWN and accept financial responsibility for the test indicated on the letter? 1. Edit the requisition and remove the test(s) that required the signature on the AWN. 2. Add AWN denial code (93147). The following message will populate on the medical report: Be advised that your patient has indicated on the advance written notice their decision not to receive the following laboratory tests. As a result, the tests will not be performed. 3. In the AOE fields enter the test(s) that were denied by the patient. 4. One of the signed letters must be forwarded as an attachment with the requisition to the laboratory for imaging. 5. The second copy is to be provided to the patient. It’s critical that the AWN contains the date, patient’s signature, and patient’s printed name on the AWN form. If patient refuses to sign the letter, please indicate that and delete testing associated with the AWN. CONFIDENTIAL – For internal circulation only

Vitamin D Coverage for Cigna Patients I have reviewed the Vitamin D Coverage for Cigna Patients and agree to comply with the procedure. CONFIDENTIAL – For internal circulation only