Cost Estimator Tool

Estimate your patients’ medical costs

Help reduce patient bad debt and eliminate financial surprises by estimating the cost of medical services for your patients.

This new cost estimator tool, which replaces the previous Cigna Cost of Care Estimator®, highlights your patient’s anticipated payment and provides an itemized, printable explanation of estimate that you can share with the patient. It’s fast to use, easy for your patients to understand, and can be used any time during your patient’s visit – prior to care, at check-in, or at checkout.


How the new tool helps you and your patients

  • Allows you to generate estimates that reflect both:
    • The benefit plan coverage for your patient with a Cigna Healthcare plan; and
    • Our current negotiated rates with your practice.
  • Provides an estimate for the specific medical services your patients may receive.
  • Shows a patient’s out-of-pocket expenses based on their Cigna Healthcare-administered medical plan (assuming they are eligible for coverage at the time they receive the service).
  • Helps facilitate financial discussions between you and your patients with Cigna Healthcare-administered medical plans so that payment arrangements can be made before treatment.

Getting started

To get started, simply complete an eligibility and benefit search for your patient and select Estimate Costs. Then, use the drop-down menus to complete the request form.


About the tool

The new estimator tool is available for all professional services in all care settings (e.g., outpatient, facility, specialty), as well as for outpatient and inpatient facility services and treatments. Please note that telehealth (i.e., virtual care) estimates are not yet available.

The tool can be used for patients covered by most Cigna Healthcare medical plans.*

Estimated costs:

  • Will be specific to the health care provider or facility requesting the estimate, the treatment or service, and the patient’s benefits at the time the estimate is generated.
  • Can be generated pre-care (at scheduling) or while the patient is in the office (before check-in or at checkout).
  • Can be printed and provided to patients to show them what their out-of-pocket expenses are estimated to be.
  • Are only available for health care providers who are contracted to participate in the Cigna Healthcare network.
  • Are not available if the provider is not in-network for the patient's plan.

Future enhancements
Additional enhancements will be coming soon, including the ability to estimate:

  • Copayment, coinsurance, and health savings account/health reimbursement account (HSA/HRA) details.
  • Costs for telehealth services.

Questions and answers

  1. How can I estimate out-of-pocket costs for my patients as of January 1, 2024?
    There are three ways you can estimate out-of-pocket costs. You can use the:


    • New cost estimator tool.
    • Patient Detail screen on the Cigna for Health Care Professionals website (CignaforHCP.com). Log in and navigate to this screen to access a patient’s deductible, coinsurance, and copayment information.
    • ANSI 270/271 transaction. Access a patient’s deductible, coinsurance, and copayment information to estimate their cost of care by submitting this transaction through your practice management system or clearinghouse.

    Your patients can also obtain their own personalized cost estimates on the Cigna Healthcare customer website (myCigna.com®) for a full range of covered medical and pharmacy services.

  2. How does the new estimator tool work?
    To use the new tool, please ensure you have the Patient Search entitlement on CignaforHCP.com and follow the steps below.

    • Log in to CignaforHCP.com. (The estimator identifies the provider through this log in.)
    • Go to Patients > Search Patients > Select a Patient > Estimate Costs.
    • Enter and submit:
      • Up to three Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS) codes, or Diagnosis Related Group (DRG) codes.
      • Place of service, service type, and other identifying information about the service(s).
      • Patient information (date of birth, Cigna Healthcare ID number, etc.).

    You will receive an explanation of estimate that details the total cost and any out-of-pocket costs for which their patient will be responsible. Note that you will need to add up each of the cost share amounts returned to determine a patient’s total out-of-pocket financial responsibility.


    Note: At this time, the new tool will not display copayment, coinsurance, or HSA/HRA details. This will be added as a future enhancement.


  3. How can I estimate the Cigna Healthcare claim coding edits?
    The new estimator tool will not display claim coding edits within the results. To determine these edits, please use the Claim Coding Edits tool by logging in to CignaforHCP.com > Claims > Claim Coding Edits.


    Please note: Claim entitlement access is needed for this tool.


  4. Am I required to use the new estimator tool?
    No. Network-participating providers can use the new estimator tool at their discretion. Patients can request an estimate from their provider, but providers are not required to provide an estimate or to use the new tool.

  5. What services does the new estimator tool include?
    The new estimator tool can estimate costs for all professional services in all care settings (e.g., outpatient, facility, specialty, etc.), as well as for outpatient and inpatient facility services and treatments.

  6. What services does the new estimator tool NOT include?
    We recommend providers DO NOT use the new estimator tool for the care outline below.


    Treatment area Rationale
    Advanced radiology Benefit details are not available for advanced radiology (e.g., magnetic resonance imaging or computerized axial tomography scans).
    Autism services Autism benefits and treatments are highly variable. There are no standard CPT codes for these services, making it difficult to produce a valid estimate.
    Chemotherapy and high-cost drugs Drug dosage is highly variable, and introduces variations to the estimate.
    Emergency room Cost is highly variable due to the care setting. Therefore, the estimates will be less accurate.
    Home health visits Cost is highly variable due to where services are delivered and what types of services are provided.
    Implants Cost is highly variable. Therefore, the estimates will be less accurate.
    Infertility Benefit coverage is variable, and often only provided for diagnosis and treatment of an underlying medical condition. A determination of coverage is typically based on diagnosis.
    Maternity Benefit details are not available for professional obstetrical services.

  7. How do I use the new estimator tool for inpatient procedures?
    To run an inpatient estimate, please select the:

    • Inpatient Hospital Facility Services as the estimate type in step 2 (Describe Service) of the estimation process.
    • Appropriate service type and provider.
    • Appropriate code and code description type.

  8. Can the estimator be used with all Cigna Healthcare-administered plans?
    No. The tool cannot be used with patients in the following Cigna Healthcare-administered plans:

    • Dental
    • Secondary (coordination of benefits)
    • Shared administration
    • Cigna Voluntary
    • Cigna Global Health Benefits®

  9. Can I use the new estimator tool if Cigna Healthcare is not my patient’s primary insurance?
    No. This is because we will not know the contract rates or benefit coverage for the primary insurer. Estimates can only be made when the Cigna Healthcare plan is the primary coverage and there is no other coverage involved.

  10. When can I run an estimate?
    You can generate the estimates at any time prior to or during their patient’s visit to the office or facility, such as at appointment scheduling, check-in or registration, pre-care, or check out.

  11. Can I use the new estimator tool to determine payments to collect at the time of service?
    The estimate results do not represent a guarantee of coverage or that coverage amounts will remain unchanged. Please use the patients’ eligibility and benefits details to determine specific deductible, coinsurance and copay information.

    If a provider chooses to collect payment at the time of service, we require that they give their patient the explanation of estimate generated by the new estimator tool. Providers can also help minimize duplicate payments or overpayments by asking their patient if automatic claim forwarding (ACF) is enabled for their HRA or HSA. ACF automatically pays providers a patient’s out-of-pocket costs from the health fund account.


  12. Do website access managers on CignaforHCP.com need to delegate access for staff to access the new estimator tool?
    Yes. Anyone that needs access to the new estimator tool will need to have the Patient Search entitlement. Website access managers will need to grant this access.

* Plans include PPO, EPO, Open Access Plus, Open Access Plus In-Network, HMO, network-EPP, HMO Open Access, Network Open Access, HMO POS-Flex, Network POS-DPP, HMO POS Open Access, Network POS Open Access, and Choice Fund.