Mercy Health may stop accepting Cigna in April

Feb. 12—LIMA — Mercy Health hospitals and medical practices in Ohio may go out of network for Cigna commercial health insurance plans on April 1 if the two parties don't sign a contract soon.

The health system and insurance company are negotiating how much Cigna should reimburse Mercy Health providers any time a patient insured through Cigna's employer-sponsored health plans is seen by a Mercy Health hospital, physician, urgent care or surgery center in Ohio.

An estimated 30,000 patients in Ohio could be affected if Mercy Health and Cigna do not reach an agreement before April 1, according to a news release from Mercy Health warning of the potential out-of-network change.

The health system is sending letters to patients this week notifying them of the situation, according to the release.

Mercy Health officials allege Cigna has not provided a rate increase for six years in some markets, where payment agreements "no longer reflect today's healthcare environment."

The health system claims Cigna's "high rates of claim denials have led to significant delays in life-sustaining care and created operational challenges to efficient patient care," according to the release.

"Nothing is more important than the relationships we have with our patients," Dr. Matt Owens, chief clinical officer for Mercy Health-Lima, said in the release. "Mercy Health is doing everything we can to avoid any network disruption for patients in Ohio, and we continue to negotiate with Cigna to provide life-saving care for our communities."

Patients insured through Cigna will continue to have access to emergency departments if Mercy Health goes out of network on April 1.

"It is disappointing that Bon Secours Mercy Health is choosing to leave our network on April 1," a Cigna Healthcare spokesperson said Wednesday in a statement to The Lima News. "Bon Secours Mercy Health notified us of their intention to leave unless we agree to their significant rate increases across multiple markets. Unfortunately, these increases would make healthcare unaffordable for our customers and their families. We hope Bon Secours Mercy Health will do what is right for the people we both serve in this community and continue working with us to reach an affordable agreement."

Owens urged people insured by Cigna to take action.

"I urge impacted patients to call Cigna at the number on their insurance card and let Cigna know how important it is to keep Mercy Health providers available and in-network," he said.

Health insurance companies routinely negotiate prices with hospitals and health networks, but those contract negotiations are increasingly a public affair as health systems like Mercy Health threaten to go out of network if insurers won't accept higher reimbursement rates they say are needed to keep pace with the true cost of care.

The disputes are often resolved without disruption for patients, but patients are still finding themselves at the center of negotiations.

Mercy Health temporarily went out of network for Anthem Blue Cross Blue Shield managed Medicaid plans in Ohio in 2023 as it negotiated rates for Anthem commercial health plans. The decision affected nearly 50,000 Ohioans.

The health system threatened to terminate a similar contract for Anthem's Medicare Advantage plans that same year, before the two parties reached an agreement setting rates through 2028.

Mercy Health patients insured through Cigna employer-sponsored health plans will continue to have access to the health system's emergency departments if their plans go out of network in April, according to a list of frequently asked questions about the contract published on the Mercy Health website.

Patients whose plans include out-of-network coverage will likely pay more for services if their plans go out of network, while those who do not have out-of-network coverage may request continuity of care from Cigna to continue treatment through a Mercy Health provider, according to the website.

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