Making the Most of Your Medical Insurance Plan: Acute Medical Needs and our Cigna Plan

Have you ever found yourself (or a family member) in need of immediate medical care for an acute, nonemergency medical issue, but couldn’t get in to see your own health care provider because you were out-of-town or the provider’s office was closed or booked? In these situations,  keep in mind that other options are available under Middlebury’s medical benefit plan.

Urgent Care and Walk-in Clinics and Express Care

Many cities and towns now have convenient options such as urgent care, express care, or walk-in care centers which can easily treat minor illnesses or injuries. While any covered service received at a licensed facility may be eligible for reimbursement by our medical plan, do keep in mind that the amount you will pay out-of-pocket may vary greatly depending on two important factors: 1) whether the provider is in- or out-of-network, and 2) whether the facility you visit codes its services using emergency room/urgent care/hospital out-patient or office visit billing codes.

  • You can minimize your out-of-pocket expenses by using in-network providers. Finding in-network facilities is easy and convenient – use the web portal or mobile app (see CIGNA Portal and App Registration for instructions on how to set up your account) and search by location or provider, or simply call the toll free number on the back of your CIGNA ID card and ask for assistance locating a provider near you.
  • Your out-of-pocket costs can also be significantly affected by a variable over which you have less control – how the provider or facility chooses to categorize and code the services for which it bills. If the facility you use codes your visit as an office visit or urgent care clinic visit then, under the terms of our plan, the deductible will not apply and you will be responsible for only 20% of the cost. However, if the facility codes your visit as hospital out-patient or emergency room care then you will have to meet your $300 annual deductible before the insurance will contribute toward the cost of the service(s). For example, here in Middlebury Porter Express Care codes their services as out-patient hospital charges which means if you use Express Care your deductible must be met before our medical plan begins paying. While a visit to Porter Express Care is likely to be less expensive than a trip to the full emergency room do keep in mind that it is also likely be more expensive than a visit to a provider’s office or an urgent care clinic visit.A convenient and cost-effect alternative for obtaining urgent care when your own health care provider is not an option is to use one of Cigna’s telehealth options. From anywhere in the US you can access a licensed medical doctor, 7 days a week/24 hours a day, via phone or video chat, for immediate advice (and a prescription called into a local pharmacy, if medically necessary) about non-emergency issues such as: sinus infections, sore throats, rashes, conjunctivitis, colds and fevers, etc. The total cost of a telehealth visit is $40 and – since there is never a deductible for telehealth services – your out-of-pocket share of the visit (20%) is only $8! Consider setting up your telehealth account now, so that the next time you need medical care while traveling, after hours or when your doctor is not available help is only a couple of clicks or a phone call away. Instructions for setting up a telehealth account can be found here: CIGNA Telehealth Brochure.

–Cheryl Mullins