At their November meeting, RECOM’s representatives on the Employee Benefits Task Force asked how COM’s Cigna plans would respond to denials of service under the WISeR program, which goes into effect in January.  That plan involves new pre-certification requirements for Medicare patients in Arizona.  The December issue of RECOM REPORTER listed many of the services involved and the review process.  You may read that article on this website under News/Newsletters/December 2025 Newsletter.

Stephanie Drake, Assistant Employee Benefits Administrator, responded to RECOM’s questions.  Here is her response:

We have confirmed with Cigna that most of the codes/services included in the WISeR program already require prior authorization through Cigna, but currently when Medicare is primary for these services, providers do not need to get pre-cert with Cigna to pay as secondary for those services.  In 2026, if a service needs to be approved by Medicare under WISeR and the service is also a Cigna/City of Mesa covered service, then the provider and/or member must complete the WISeR pre-certification process for Medicare to approve and pay primary and Cigna will automatically coordinate benefits in secondary position (just like current).  However, if WISeR denies Medicare coverage for otherwise potentially covered services under the City/Cigna retiree medical plans, then the provider would need to submit for pre-certification/authorization with Cigna and if Cigna approves, then they will adjudicate the claim in primary position (i.e., no Medicare involvement).  If neither approves, then (there will be) no coverage for that set of codes and clinical requests under either Medicare or Cigna/City.