1. United States
2. Pa.
3. Letter

I am writing to express my serious concerns about a new policy being implemented by Cigna Healthcare. Effective October 1, 2025, Cigna will begin implementing its Evaluation and Management Coding Accuracy (R49) policy. This policy will allow Cigna to automatically "downcode" or reduce the reimbursement level for certain high-level evaluation and management (E&M) services, even without a prior review of the patient's full medical records. This move is deeply troubling for several reasons: Impact on Patient Care: This policy places a significant administrative burden on healthcare providers and may discourage them from spending the necessary time on complex patient cases, potentially jeopardizing the quality of care. Increased Administrative Burdens: Physicians will now have to dedicate more time and resources to appealing these automatic denials, diverting attention away from their primary focus: patient treatment. Undermining Professional Standards: Cigna’s policy appears to be inconsistent with nationally recognized coding guidelines from organizations like the American Medical Association (AMA). I urge you to investigate this matter and call on Cigna to rescind this burdensome and potentially harmful policy. It is critical that we ensure healthcare providers are fairly compensated for the care they provide and that patients have access to the services they need without unnecessary barriers. As someone with chronic and autoimmune conditions, I am personally and deeply affected by this. My ongoing health requires frequent, high-level consultations with my doctors. These visits are critical for managing my complex health needs, and they involve a significant amount of medical decision-making. My doctors need to be fairly compensated for this essential work. If this policy goes into effect, I am concerned it will lead to physicians either reducing the time they spend with me or, in a worst-case scenario, choosing to stop accepting Cigna altogether, leaving me without access to the care I need. Thank you for your attention to this important issue. I look forward to your response and hope you will take action to protect patients and healthcare providers in our community.