Can allowed amounts change mid-year for out of network care?

Hello,

I have a Cigna plan through my employer that offers out-of-network coverage. Out of necessity, I see a few long-term providers out-of-network on a weekly basis.

At the beginning of the year, I called Cigna to ask what the allowed amounts were for these providers. I supplied CPT codes and the providers’ zip codes and received allowed amounts back from Cigna. These allowed amounts were consistent with what I was reimbursed in the first couple months of claims I submitted for these providers. Midyear, however, the allowed amounts for most of my providers dropped $50. In the case of one provider, the allowed amount dropped $25 for a month or two and then went back up to the previous rate.

Can someone explain why this happened? My Cigna plan reimburses based on Medicare rates. Do Medicare rates fluctuate throughout the year? I was surprised that Medicare rates would drop. When can Medicare rates change? At any time? Do I have any recourse or, at least, any way to not have the rug pulled up from underneath me like this?

Thank you.

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