Claims & Guarantee of Payment (GOP)

Change to Guarantee of Payment (GOP)

To prevent you from having to pay for the total cost of your medical treatment in advance, it is recommended that you arrange for a Guarantee of Payment with Cigna.

A Guarantee of Payment (GOP) states whether or not the required treatment is covered and what portion of the expense is covered by Cigna. You will pay your portion of the required deductible and coinsurance to the healthcare provider, and Cigna will pay its portion of the costs directly to the healthcare provider. Please note that Cigna will only issue a Guarantee of Payment for medical care expenses over USD 400. However, for medical expenses between USD 200 to USD 400, Cigna can issue a Verification of Benefits to the healthcare provider to confirm that Cigna will make the payment for the treatment.

It is also recommended that you use Cigna in-network providers for planned or emergency hospital admissions because a Guarantee of Payment or Verification of Benefits will be easier and faster to obtain than for out-of-network providers. For out-of-network providers, you may have to pay the provider in full in advance, and then submit the claim to Cigna for reimbursement.

To arrange for a Guarantee of Payment, please follow these steps:

1. Find a Cigna in-network hospital by logging in to your Cigna Personal Webpage in the Cigna website and search for an in-network healthcare provider.
2. Download the Cost Estimate Form from your Cigna Personal Account and have your healthcare provider complete the form. The Cost Estimate Form requests the following information from the healthcare provider or hospital:
   • name and contact details of the health care provider;
   • diagnosis;
   • treatment;
   • date of admission and discharge;
   • other medical expenses (medical, x-rays, lab, etc.);
   • hospital room type;
   • currency of payment.
3. This form must be completed by your provider and returned to Cigna no later than two weeks prior to the scheduled procedure. If using the paper form, send a scan by email to admissions@cignahealthcare.com.
4. Cigna reviews the information submitted and returns to you and to the provider an authorized copy of the Guarantee of Payment form.
5. Upon admission, you must show your Cigna insurance card and the Guarantee of Payment document to the healthcare provider. Cigna will settle the bill directly with the provider. You will only have to pay your patient portion.

For a planned medical treatment or hospital admission, send a GOP request to Cigna at least two weeks prior to the scheduled procedure by email at admissions@cignahealthcare.com. The more time that Cigna has to negotiate the Guarantee of Payment with the healthcare provider, the better the chance that your estimated cost will be lower.

In case of an emergency hospitalization, you will need to contact Cigna as soon as possible to provide admission and hospital contact details. If you are waiting to be admitted to a hospital, Cigna will assist in finding a Cigna in-network hospital. If you are admitted to a hospital outside of the Cigna network, Cigna will try to prepare a guarantee of payment document to arrange payment with the hospital directly.