Cigna commercial health plans may go out-of-network at large local hospital group

Feb. 12—Consumers with some employer-sponsored Cigna health insurance plans may find themselves out-of-network with Mercy Health facilities on April 1 if the two health care organizations are not able to reach a deal on contract negotiations by then.

Mercy Health, which has locations in Springfield, Urbana and southern Butler County, is one of the largest health systems in Ohio. It is warning patients on employer-sponsored Cigna plans they may lose in-network insurance coverage because negotiations on reimbursements have soured after months of effort.

"Nothing is more important than the relationships we have with our patients," said Dr. Joe Morman, chief clinical officer at Mercy Health — Springfield Regional Medical Center.

In some key markets, Cigna has not provided a rate increase in six years, according to Mercy Health. Cigna also has high rates of claim denials, which have led to significant delays in life-sustaining care and created operational challenges to efficient patient care, Mercy Health said.

"We are committed to preventing any disruption in care for our patients and are still actively trying to negotiate with Cigna to ensure continued access to lifesaving services in our communities," Morman said.

Billions in earnings

Mercy Health notified Cigna of its intention to leave its network unless Cigna agreed to "significant rate increases across multiple markets," a Cigna Healthcare spokesperson said, adding it is "disappointing that Bon Secours Mercy Health is choosing to leave" the network on April 1.

The increases Mercy Health is asking for would make health care unaffordable for Cigna customers, according to Cigna.

Shareholders of the Cigna Group, the parent company of Cigna Healthcare, saw a net income of $3.4 billion for 2024, according to the Cigna Group's posted earnings.

Total revenues for 2024 increased 27% to $247.1 billion, the Cigna Group said, adding that the Cigna Group's Board of Directors declared an 8% increase in quarterly payments to shareholders in 2025.

For Cigna Healthcare alone, the health insurer reported revenue of more than $52.9 billion in 2024, up from $51.2 billion in 2023. It reported earnings of $4.2 billion in 2024, a pre-tax operating margin of 8%.

Struggling with operating expenses

Bon Secours Mercy Health, the parent nonprofit that Mercy Health — Springfield Regional Medical Center and other Mercy Health locations fall under, operates 49 hospitals and more than 1,200 sites of care in the U.S. and Ireland. All of its sites combined employ more than 60,000 people.

Despite reporting a net operating revenue of more than $12.2 billion in 2023, Bon Secours Mercy Health's operating expenses exceeded $12.3 billion, according to bond filings from the hospital system. Operating losses were nearly $123.9 million.

When taking investment gains and other non-operating revenue sources into account, Bon Secours Mercy Health had earnings of $222.4 million in 2023, up from a $1.2 billion loss in 2022, according to its bond filing. The $1.2 billion loss in 2022 included an operating loss of $323.5 million and $925.3 million in investment losses.

Bon Secours Mercy Health said it spent more than $600 million in annual community benefits across five states.

Patients with a Cigna commercial plan can continue to see their Mercy Health providers through March 31. Unless an agreement on a new contract is reached, beginning April 1, Mercy Health hospitals, physicians, urgent cares, ambulatory surgery centers and other care sites in Ohio will no longer be in the Cigna network.

Should Mercy Health go out of network, all patients will have access to care in the event of an emergency, the hospital said.

Cigna patients impacted by these negotiations were notified by letter. More information can be found at www.mercy.com/cigna-updates.

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