Take Control of Your Care
 
 

Take Charge by Getting All the Information You Can

Shop for Services With Our Treatment Cost Estimator and Provider Search Tool

Available through the member portal—so it can tailor results based on your specific plan—our treatment cost estimator and provider search tool lets you shop for affordable, quality health care just like you would for anything else.* And it lets you know what to expect before your visit.

It’s the only tool that determines the services, timelines, and costs for a complete treatment of care—from diagnosis through follow-up. It even shows the medications you’ll need.

Log onto our member portal to get started.

*Does not apply to Carelink members searching for care outside of MA/RI/NH.

Digital Tools You Can Use

With a suite of digital tools that help you make smarter health care decisions and give you the information you want, when you want it. Start taking advantage of these tools today to save time and money!

  • Telehealth, powered by Teledoc* - 24/7 access to a doctor through the convenience of phone, video, or mobile app visits.
  • MyWire* - Receive important, personalized health communications, such as reminders for annual doctor’s visits and screenings, tips for saving money on your care, member discounts and more.
  • Tufts Health Plan Mobile App - We’ve taken the top four things members want to do online and put them into our mobile app. Now you can do them quicker and easier than ever.

*Ask your employer if your plan benefits include Telehealth and MyWire.

We Are Here to Help You

​Special Programs for New Moms and Moms-to-Be

  • Maternity Support - We go the extra mile. Literally. Once your baby (or babies!) arrives, you could be eligible for post-delivery support and services, including a home visit to make sure everything is fine and to answer any questions you may have.
  • Cigna Healthy Pregnancies, Healthy Babies® - A Cigna case manager, who is trained as a nurse, supports moms at risk for preterm labor or with underlying complex medical conditions through pregnancy and delivery, to help ensure a positive transition to home.

Talk to a Nurse 24/7

Have a medical concern and not sure what to do? Just call Nurse 24 at 866-201-7919 for immediate and reliable health advice and information. Registered nurses are available 24 hours a day, 7 days a week to answer any of your health questions, including concerns about:

  • Symptoms you are experiencing
  • Minor illnesses and injuries
  • Chronic conditions
  • Medical tests and medications
  • Preventive care
  • Doctor visit preparation

Do You Have a Chronic Condition

Sometimes people with chronic conditions, such as diabetes or heart failure, may benefit from some help managing their health. If you’re a candidate, Cigna may reach out to you about care management programs and services you are eligible to receive. A case manager trained as a nurse can assist you with education, symptom management, prescription management and much more.

Care for Members With Chronic Conditions

Conditions such as heart disease, cancer and stroke require special attention. For complex conditions, a Cigna case manager trained as a nurse will help you get the medical care and support you need throughout the various stages of your treatment.

Get the Preventive Care You Need: Talk to your doctor about the routine health screenings and immunizations that you should have. Designed to keep you healthy, preventive care is covered 100%.

Take Time for Yourself

Behavioral Health

Our holistic approach to your health involves the deep integration of medical and behavioral health programs. We’re managing the whole person to achieve better results. Although behavioral health care is often overlooked by individuals and their families, we encourage you to take advantage of your benefits if and when you need them.

We provide a wide range of behavioral health benefits and support, including:

  • Inpatient access to behavioral health and substance use disorder services
  • Outpatient behavioral health and substance use disorder benefits
  • Help with understanding addiction and available treatment options
  • Applied Behavioral Analysis (ABA) services for Autism Spectrum Disorders

The Right Care in the Right Treatment Setting

Our Utilization Management Program

We want you to have the care you need to stay healthy. However, we also want to make sure services aren’t overused or used inappropriately, which drives up costs for everyone.

That’s the idea behind our Utilization Management (UM) program: to help you receive quality health care in an appropriate treatment setting. Through this program, we make coverage decisions about care based on careful evaluation of available clinical information.

We Know Health Care Can Be Complicated

UM evaluates requests for coverage by applying medically and necessary coverage guidelines (clinical criteria guidelines) to determine the medical necessity and appropriateness of the health care services under your benefit plan. These guidelines include the following:

  • Prospective (Before Treatment): We determine whether a treatment is medically necessary before it begins.
  • Concurrent (During Treatment): We review treatment during the course of care to determine medical necessity.
  • Retrospective (After Treatment): We review treatment for medically necessity after treatment is complete.

For services and prescriptions that require preauthorization, we conduct pre-service reviews. If you are hospitalized, we review all available information to help provide a smooth transition from hospital to home, or from hospital to another health care environment. Reviews are also conducted post-service to review prescriptions and other medical needs.

Who makes utilization management decisions?

For medical coverage decisions, denials are made only by board-certified physicians.

For pharmacy coverage decisions, denials are made only by board-certified physicians or registered pharmacists.