‘Healthcare is hard enough. Cigna's new rule is about to make it worse’
Industry Buzz
"In the long run, there are going to be physicians overburdened by this and will start to drop Cigna Healthcare because of this type of unfair practice.” — Zachary Rubin, MD, @rubin_allergy
“[It’s a] big blow… In addition to doing prior authorizations, and fighting for all of the medications, and fighting for all of the procedures that we've been doing, now we are going to have to fight to get basic office visits paid. [It's also] creating a layer of burden once more for the patient, because maybe now also the physician may decide, ‘Hey, we're not going to take Cigna, because we don't want to not be paid fairly for the amount of time and for the work that we are putting in.’” — Priya Bansal, MD, @allergygalmd
One of the nation’s biggest insurers is rolling out a new policy, but this isn’t the kind of health reform anyone was asking for.
Cigna Healthcare's recent announcement is drawing sharp pushback from the medical community: Starting October 1, 2025, the insurer will automatically downcode level 4 and level 5 E/M office visits—new and established—without reviewing medical records first.
Translation: Unless you actively appeal with documentation, expect those visits to be reimbursed at a lower level... by default.
Docs brace for impact
Doctors on TikTok are disheartened by the news, worrying not only about what it will mean for their workload, but also what it will mean for their patients.
"They're gonna pay doctors less for the services rendered, unless they send in appeals where they have to actively send out a bunch of paperwork, which takes time away from taking care of patients," said Zachary Rubin, MD, in a recent TikTok video. "In the long run, there are going to be physicians overburdened by this and will start to drop Cigna Healthcare because of this type of unfair practice.”
Related: Trump's 'big, beautiful bill' impacts MDs, and this surgeon isn't staying quiet—should you?Allergist Priya Bansal, MD, also shared her thoughts: "The patient now in addition to having delay for their drugs, they're not gonna get the office visits paid correctly; maybe they budgeted a simple amount for their HSA, but now this isn't going to be covered because we're fighting, and they don't know the true amount that's due for the claim. [It’s] creating a layer of burden once more for the patient, because maybe now also the physician may decide, ‘Hey, we're not going to take Cigna, because we don't want to not be paid fairly for the amount of time and for the work that we are putting in.”
This comes on top of the prior auth battles you already face for drugs and procedures. The added burden? Filing paper appeals and faxing full charts just to justify coding you’ve already substantiated in the note.
“[It’s a] big blow… In addition to doing prior authorizations, and fighting for all of the medications, and fighting for all of the procedures that we've been doing, now we are going to have to fight to get basic office visits paid,” Dr. Bansal said.
Why this hits hard
Administrative overload: Every denied or downcoded claim pulls time away from patient care. For smaller practices, the extra paperwork can be unsustainable.
Patient impact: When payment disputes delay claim adjudication, patients may get inaccurate EOBs or unexpected bills. If they’ve budgeted for care via HSAs, that uncertainty compounds.
Access risk: Some practices may decide it’s no longer viable to stay in-network with Cigna. If the policy spreads to other carriers—as many fear—patients could face reduced access across multiple insurers.
The downstream effects are more than theoretical. Doctors on TikTok warn that widespread adoption could normalize algorithmic downcoding across payers. And in states like California, organized medicine groups have already questioned whether the policy conflicts with laws around transparent payment criteria. Elsewhere, it may be “legal but unfair,” leaving advocacy as the main lever.
What's the next move?
Audit documentation for high-level E/M visits; ensure MDM, time, and diagnoses are airtight.
Prepare an internal workflow for quick appeals. Cigna’s policy anticipates you’ll send full records proactively when challenged.
Engage with specialty societies and state medical associations—legal or legislative pushback is more effective when organized.
As Dr. Rubin summed it up: "Healthcare is hard enough. Cigna's new rule is about to make it worse." Whether or not you see Cigna-insured patients, this is a bellwether worth watching—and, perhaps, challenging—before it becomes the norm.
Read Next: Docs split: Prior auth relief or just another empty promise?