Cigna has opted not to reimburse a facility fee and consider a one-room surgical center in New Jersey for in-network participation, despite the center’s licensure from NJDOH, according to Mr. Shanton.
“The center in question has attained licensure from the NJDOH and meets all the requirements of a surgical facility according to DOH regulations,” says Mr. Shanton. “Thus Cigna is intentionally failing to recognize the lawful status of the entity in question, as a licensed surgical facility as defined under N.J.A.C. 8:43A-2.3.”
The inability to go in-network with Cigna could have a detrimental effect on the surgical center because Cigna members would not have coverage at the center.
“Cigna first refused to negotiate with this center because it was an unlicensed provider,” said Mr. Shanton. “The center attempted to point out that it was now licensed by NJDOH, but Cigna then stated because it was only a one-operating room surgery center, they would not negotiate or reimburse for facility fees even if licensed. Because of this, NJAASC felt it was necessary to ask both Departments to investigate and take action.”
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