Together with our clients, we have developed a series of cost-containment strategies and mechanisms to help keep your benefits plan financially viable over the long term.
Determining reasonable & customary expenses
Our databases are enriched with the details of 4,5 million medical bills and 42,000 hospitalisations each year. Combined with our in-depth knowledge of local social security systems, this unique dataset of claims allows us to identify the level of reasonable and customary medical expenses.
We examine cases according to a great variety of factors: type of treatment, hospital, country, diagnosis, or treating physician. We then define with great precision the reasonable and customary rates on specific markets or for specific treatments – and identify outliers. Greater cost control for your organisation is our focus.
Case management – in everyone’s interest
Our case managers look for economical treatment solutions, adapt the length of stay and negotiate rates on top of the ones already agreed with our Provider Relations department. We keep close contact with the patient throughout the admission process. Day in, day out, our case management team strives to find the right balance between maintaining your employees’ comfort and well-being and cutting down on your employee benefits costs. Our International Medical Board is available to review files – while safeguarding the patient’s right to treatment at all times.
A well-targeted anti-fraud policy
Fighting against fraud is one of our top priorities.
Health insurance, especially in an international context, is a sector that is typically prone to fraud. Cigna has implemented a strict anti-fraud policy based on prevention, detection, investigation, reporting, and recovery. The measures we have taken fall into four categories:
- creating fraud awareness amongst plan members;
- establishing a general control environment;
- developing specific measures for fraud prevention and pre-payment fraud detection;
- developing specific measures for post-payment fraud detection.
Created in 2008, our Fraud Investigation Unit plays a vital role in our anti-fraud strategy. It closely cooperates with the Claims Units as fraud monitoring is an important part of the claims handling process and as new fraud files are often initiated at that stage. The Fraud investigation unit also relies on international networks to keep informed of all new health care fraud trends and techniques.
Cigna has been a member of the European Healthcare Fraud and Corruption Network (EHFCN) since July 2009.