CA HMO providers arranging for medically necessary network exception requests

April 1, 2024

Providers in California that participate in a health maintenance organization (HMO) network are required to arrange and deliver medically necessary services in a timely manner consistent with state and federal time frames and geographic access standards. The California Department of Managed Health Care enforces these requirements to ensure individuals receive timely access to medical and behavioral care.

Financial responsibility

When your patient requires medically necessary care by a nonparticipating provider and, based on your medical group’s contracted division of financial responsibility (DOFR), you believe the services rendered are the financial responsibility of:

  • Cigna Healthcare, please complete and fax a network exception request form directly to us at 800.558.3710.
  • Your group (and its affiliated physicians), it is not necessary to fax a network exception request form.

However, whether Cigna Healthcare or your group is financially responsible for your patient’s medically necessary out-of-network care, it is still your responsibility to ensure it is arranged within the time frame and geographic standards required by California law.* 

Language assistance

For all appointment types, you can access free interpreter services to support your patient at the time of the appointment when they do not speak English** by calling the phone number on the back of your patient’s Cigna Healthcare ID card.


If you have questions or need assistance, please refer to the contact information below.

Cigna HealthcareCustomer service:   Call the phone number on the back of your patient’s ID card
California Department of Managed Health Care (regulates HMO plans)Helpline: 888.466.2219
TDD line for the hearing and speech impaired: 877.688.9891

* Cigna Healthcare. “California HMO Provider Appointment Access and Availability.” Network News. Fourth Quarter 2023.

** California Language Assistance Program Provider Training.  

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