Does Cigna Open Access Plus require referrals? No. With a Cigna Open Access Plus (OAP) plan, you can see any in-network specialist without a referral from a primary care doctor. Choosing a primary care provider is recommended, but it isn't required. The same is true for Open Access Plus In-Network plans, as long as you stay in the network. However, some services still need prior authorization, which is a different step that your doctor handles with Cigna.
- Cigna OAP and OAP In-Network plans don't require referrals to see in-network specialists.
- Picking a primary care provider is recommended for coordinated care, but optional.
- Prior authorization is not a referral. It may still apply to hospital stays and some outpatient care.
- Cigna HMO and SureFit plans work differently, and a primary care doctor may coordinate your care.
How Referrals Work on Cigna Open Access Plus
A referral is a written OK from your primary care doctor before you see a specialist. Many HMO plans require one. Cigna OAP plans don't.
So if you need a dermatologist, cardiologist or orthopedist, you can book directly. Just make sure the specialist is in the Open Access Plus network, since in-network care costs the least. Before you book, check if the doctor is in network.
Do You Need a Primary Care Doctor?
No, but Cigna recommends one. A primary care provider can handle checkups and follow-up care, and help coordinate your specialists. In addition, some plans charge less for a primary care visit than for a specialist visit.
Cigna doesn't automatically assign you a primary care provider on an OAP plan. If you want one, you can choose it in myCigna. Need help? Read our guide to choosing a primary care doctor.
Even without a referral rule, pick a primary care doctor anyway. One doctor who knows your history can catch problems early and steer you to specialists your plan covers well.
Referrals vs. Prior Authorization
These two terms get mixed up, but they aren't the same thing.
| Referral | Prior authorization | |
|---|---|---|
| What it is | Your primary care doctor approves a specialist visit | Cigna approves a service before you get it |
| Needed on Cigna OAP? | No | Sometimes, for hospital stays and some outpatient care |
| Who handles it | Your primary care doctor | Usually your in-network doctor or hospital |
| If it's skipped | Not an issue on OAP | The claim may cost more or be denied |
For example, one Cigna OAP plan charges a $750 penalty if required pre-authorization is skipped. So before a scan or surgery, ask your doctor's office whether they've cleared it with Cigna. Questions? Call 888-730-6001.
A licensed Vivna agent can explain your options, from individual plans to dental, vision and supplemental coverage, at no cost.
Referral Rules by Cigna Plan Type
| Cigna plan type | Referrals for specialists | Primary care doctor |
|---|---|---|
| Open Access Plus | Not required | Recommended, not required |
| Open Access Plus In-Network | Not required in network | Recommended, not required |
| PPO | Not required | Not required |
| LocalPlus | Not required | Not required |
| HMO | Varies by plan | Often coordinates your care |
| SureFit | Varies by plan | Required |
Not sure which plan type you have? Check your Cigna ID card or myCigna account. Then see how they compare in our guide to Cigna plan options, or read HMO vs. PPO plans.
How to See a Specialist the Smart Way
- Confirm the network. Search the Cigna directory, then call the office to double-check.
- Ask about prior authorization. Especially for imaging, procedures and surgery.
- Check your costs. Specialist copays are often higher than primary care. Use the Cigna cost estimator in myCigna.
- Keep your primary doctor in the loop. Ask the specialist to send notes back to them.
Going outside the network? Costs rise fast. Read how Cigna OAP out-of-network coverage works first.
Does Cigna Open Access Plus Require Referrals: FAQs
Can I see a dermatologist without a referral on Cigna OAP?
Yes. You can book any in-network specialist directly.
Do I need a referral for an OB/GYN?
No. On Cigna OAP, you can see an in-network OB/GYN without a referral.
Does Cigna OAP In-Network require referrals?
No. You can see network specialists without one. Out-of-network care is covered only in emergencies.
Do I need a referral for mental health care?
Not on OAP. Some services may still need prior authorization, so check your plan.
Is Cigna OAP an HMO?
No. It works more like a PPO. See Open Access Plus vs. PPO vs. HMO.
Changing jobs or adding dental and vision? We'll compare plans for you. Call Monday through Friday, 9am to 6pm.
Sources
- Cigna: Open Access Plus plans
- Cigna for Health Care Professionals: Open Access Plus and OAP In-Network
- Cigna: Employer medical plan types
- Sample Cigna OAP benefits summary (Otero County, CO)
Plan rules vary by employer and state. Your Summary of Benefits and Coverage and plan documents have the final word. Vivna Insurance is a licensed, independent agency (NPN 19168641) and an appointed broker with Cigna for select products. We are not Cigna and don't administer employer plans.
Related guides
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