Cigna Pathwell Bone & Joint is a musculoskeletal care program with designated surgeons and navigation, per Cigna.
Cigna describes Pathwell Bone & Joint as a condition-specific care program for spine, hip, knee and shoulder pain. It combines clinical navigation, designated providers and a benefit design that rewards optimal care choices.
What the program is and what members do.
What the program is
Cigna says Pathwell Bone & Joint helps employees with spine, hip, knee or shoulder pain get on the right treatment path, avoid unnecessary surgeries and reduce the organization’s spend. Cigna lists designated providers who meet quality and cost criteria, clinical navigation and benefit design that rewards customers for optimal care choices.
How members use it
Cigna says a Clinical Care Advocate works one on one with employees by digital messaging or phone, and a guided digital experience offers personalized activities, assessments and treatment guidance. If surgery is needed, a Benefit Specialist explains how to qualify for the zero or low-cost surgery benefit and travel benefit.
What it covers and does not
Cigna’s footnote says that when program participation requirements are met for covered surgeries, a non-HSA plan pays 100 percent of eligible expenses, and an HSA plan pays 100 percent after the deductible is met. The travel benefit applies to surgery with a designated provider more than 60 miles from home, and the amount varies. Cigna also says advocates are licensed nurses and physical therapists who do not give medical advice in that role.
Eligibility, funding and plan design.
Who can use it
Cigna describes employees with spine, hip, knee or shoulder pain, and says it uses predictive models to reach customers at risk for such surgery up to one year in advance. Cigna says timing and results may vary.
How it is funded or sold
Cigna presents it to employers as part of a benefits package. The surgery benefit is a plan design feature, so the employer’s plan pays when participation requirements are met. Cigna says product availability varies by location and plan type and is subject to change.
Where it fits in plan design
It is a point solution with a plan-design component: it ties member cost to using designated providers. We would model it against the group’s actual musculoskeletal claims and review network access for your area.
What to settle before relying on it.
Are designated providers near our employees?
We would ask Cigna for the designated surgeons and facilities in the areas where the group’s employees live.
How do participation requirements work?
The surgery benefit depends on meeting participation requirements. We would ask for them in writing and how members who skip the program are treated.
What is the cost to the group?
Cigna does not state a price. We would ask for the fee, if any, and how Cigna measures savings.
Common questions about this program.
What conditions does it address?
Cigna names spine, hip, knee and shoulder pain, including low back and osteoarthritis of the hip and knee.
Does the member pay for surgery?
Cigna says the plan pays 100 percent of eligible expenses for non-HSA plans when requirements are met, and after the deductible for HSA plans.
Who are the care advocates?
Cigna says nurses and physical therapists with a current licensure, who do not provide medical advice in that role.
Where these details come from.
This page summarizes what Cigna publishes. Programs change, so confirm current details with the carrier before relying on them.
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