Orthopedic Surgeons That Accept Cigna
1 verified providers accept Cigna
About Cigna
Cigna covers about 17 million medical members. Mid-sized compared to UHC or Aetna, but its provider networks are extensive, particularly for employer-sponsored plans. Cigna leans into wellness and preventive care messaging, reflected in tiered plan structures where using preferred providers costs noticeably less than other in-network providers.
Orthopedic Coverage Overview
Cigna covers orthopedic visits, imaging, rehab, and surgery. Most plans use a tiered network. Preferred providers cost less than non-preferred in-network providers, and out-of-network care is much more expensive on most plans. Prior authorization is required for most orthopedic surgeries and for advanced imaging like MRI in many cases. Self-pay rates are generally available for patients without coverage.
Cigna Plan Types
Cignasells multiple plan products and they don't all share the same orthopedic network. Confirm the specific plan name with the office when scheduling.
Cigna Open Access Plus (OAP)
Cigna's most common PPO product for employer plans. No referrals; broad orthopedic network. Tiered cost-sharing structure rewards using preferred in-network providers.
Cigna LocalPlus
Tighter regional network at lower premium. Smaller orthopedic surgeon list — verify acceptance carefully when scheduling.
Cigna SureFit
Tailored network plans common in specific markets. Often pairs with a specific health system, so orthopedic care is concentrated within that system.
Cigna Medicare Advantage
Separately networked from commercial Cigna. Primarily strong in Arizona, Colorado, Tennessee, Florida, Texas.
Common Orthopedic Procedures and Cigna Coverage
How Cigna typically handles the most common orthopedic surgeries. Coverage rules can vary by specific plan — verify with your benefits documents.
Out-of-pocket ranges below are estimates aggregated from CMS facility-charge data, plan-tier comparisons, and reported member experiences. Actual costs depend on your specific employer plan, deductible, network status, and the surgeon's contract with Cigna. Always confirm with Cignamember services and the surgeon's billing office before scheduling.
| Procedure | Cigna Coverage Notes |
|---|---|
| Total Knee Replacement | Covered with prior auth. Cigna designates Cigna Centers of Excellence facilities for joint replacement on some employer plans, with reduced cost-sharing or covered travel for members who use them. |
| Total Hip Replacement | Same coverage and Center of Excellence program as knee replacement. Outpatient hip replacement is approved when criteria are met. |
| ACL Reconstruction | Covered. Prior auth typically required for the surgical procedure. Cigna covers PT before and after ACL surgery on most plans. |
| Rotator Cuff Repair | Covered as outpatient surgery. Cigna sometimes requires conservative care documentation before approving surgical repair, particularly for partial-thickness tears under age 65. |
| Spinal Fusion | Covered with rigorous prior auth. Cigna applies strict clinical criteria including 6+ weeks of conservative care and specific imaging findings. Denials are appealable via peer-to-peer review. |
| MRI (Knee/Spine/Shoulder) | Most Cigna plans require prior auth through eviCore. Approval criteria are similar to other carriers — failed conservative care or red-flag symptoms. |
Prior Authorization
Cigna uses eviCore Healthcare for radiology and select surgical benefit management, with internal review for major orthopedic surgery. Approvals typically take 5-7 business days for surgery, 2-4 days for imaging. Members can track status on mycigna.com or the Cigna app.
Network Strength
Cigna has strong commercial orthopedic networks in Texas, Tennessee, Connecticut (its home market), Florida, and Arizona. Network is more constrained on tiered plans (LocalPlus, SureFit) where the cheapest tier may exclude many surgeons. PPO networks are competitive with UHC and Aetna in major employer markets.
Things to Watch With Cigna
- Tiered network plans (Cigna OAP, LocalPlus) charge significantly more for using a "Tier 2" in-network provider versus a "Tier 1" preferred provider — confirm the surgeon's tier when scheduling.
- Cigna Centers of Excellence program for joint replacement isn't universal — verify if your specific plan includes it.
- Cigna marketplace plans (healthcare.gov) have narrower networks than employer Cigna; verify the specific plan name when scheduling.
- eviCore denials of MRI follow the same clinical criteria as UHC and Aetna and are reversible with peer-to-peer review.
Providers Accepting Cigna
Showing 1-1 of 1 providers
Cigna by Specialty
Frequently Asked Questions About Cigna and Orthopedic Care
How do I find an orthopedic surgeon that accepts Cigna?
Use the AdvOrtho search to browse orthopedic surgeons and filter by insurance plan. Providers who have verified their Cigna acceptance appear in results. Always confirm with the office directly when scheduling — networks change and the specific Cigna product matters (PPO vs HMO vs Medicare Advantage may have different acceptance).
Does Cigna cover orthopedic surgery?
Cigna generally covers medically necessary orthopedic procedures including joint replacement, ACL reconstruction, rotator cuff repair, and spinal surgery. Coverage details, deductibles, and prior authorization requirements vary by plan type. Review the section above for plan-specific details, or contact Cigna directly for your exact benefits.
Do I need a referral to see an orthopedic surgeon with Cigna?
It depends on your Cigna plan type. HMO plans typically require a referral from your primary care physician. PPO and POS plans usually allow direct access to orthopedic specialists without a referral, though some HMO products allow self-referral within their network.
How many orthopedic surgeons accept Cigna?
AdvOrtho lists 1 orthopedic providers who have indicated they accept Cigna. Provider networks change regularly — confirm acceptance directly with the office before scheduling, especially for elective procedures.
What is the difference between Cigna Tier 1 and Tier 2 in-network providers?
Cigna Open Access Plus and similar tiered plans rank in-network providers into preferred (Tier 1) and standard (Tier 2) categories. Tier 1 providers cost less because Cigna negotiated better rates with them. Tier 2 providers are still in-network but trigger higher copays and deductibles. Always confirm an orthopedic surgeon's tier before scheduling.
How does Cigna's Centers of Excellence program work for joint replacement?
Cigna designates specific facilities as Centers of Excellence based on outcome data, complication rates, and volume. On employer plans that include the program, using a designated facility for total knee or hip replacement reduces or waives certain cost-sharing. Some self-funded employer plans even cover travel and lodging for members traveling to a Center of Excellence.
Does Cigna require a referral for an orthopedic specialist?
PPO and Open Access Plus plans do not require referrals. Some HMO and tiered plans require referrals from primary care for specialist visits. Check the plan name on the back of your card.
Is Cigna marketplace (ACA) coverage the same as employer Cigna?
No. Cigna marketplace plans have substantially narrower networks than employer Cigna. A surgeon who accepts Cigna through your job may not accept Cigna through healthcare.gov. Always verify with the specific plan name.
How long does Cigna prior authorization take for orthopedic surgery?
Standard requests typically take 5-7 business days. Urgent requests are reviewed within 72 hours. Most orthopedic offices wait for written approval before booking the surgery date.
Insurance coverage information is provided for general guidance only. Always verify coverage details, copays, and prior authorization requirements directly with Cignaor your provider's office before scheduling treatment.
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