Document Interpretation Service Requests

California

To help behavioral health care professionals document and track their compliance with California's Health Care Language Assistance Act, Cigna is pleased to provide a generic Request/Refusal for Interpretation Services form. This form – available in English, Spanish, and Traditional Chinese – may be offered to any non-English speaking patient, regardless of insurer.

California Language Assistance Program Requirements

Under the Health Care Language Assistance Act, customers who live in the state of California have the right to an interpreter when receiving health care treatment and services. In compliance with this law, Cigna requires the following:

• All health care professionals and office staff must offer Cigna's phone interpreter vendor when speaking to any Cigna customer in any non-English language. Even if a health care professional or office staff speaks in the customer’s language, the phone interpreter vendor must always be offered.
• Cigna does not delegate language interpretation services to its health care professionals. Health care professionals are required to offer free over-the-phone interpretation services directly to Cigna customers through Cigna’s phone interpreter vendor.
• If a customer prefers to use a family member or a friend to provide interpretation services after he or she has been told that a trained interpreter is available free of charge, the customer’s refusal to use the trained interpreter must be documented in his or her medical record when in a health care professional setting.

How to access the form

You can download and print the generic Request/Refusal for Interpretation Services form in English, Spanish, or Traditional Chinese. You can also obtain printed copies by calling customer service at 1.800.88Cigna (1.800.882.4462) or directly access the forms below.

Request / Refusal for Interpretation Services form - English

Request / Refusal for Interpretation Services form – Spanish

Request / Refusal for Interpretation Services form – Traditional Chinese

For more details:

California Language Assistance Program