ProMedica hospital and employed physicians have stopped accepting health insurance coverage from Cigna members because of a protracted dispute over rates for care and services.
ProMedica terminated its commercial contract with Cigna Monday, forcing patients who still wanted to use ProMedica providers to pay out of pocket.
It’s the latest clash between local hospitals and health insurers that has left patients caught in the middle.
In September, Mercy Health, whose local flagship hospital is Mercy Health St. Vincent Medical Center, settled a rate dispute with Anthem of Ohio that had left about 26,000 local Anthem Medicaid enrollees without insured access to Mercy facilities for three months.
Cigna said in a statement Monday that ProMedica is demanding a 15 percent rate increase and that acceding to those “unreasonable demands” would make health care more expensive for customers.
“It is disappointing that ProMedica is forcing our shared patients to lose in-network access to their facilities by choosing to leave our network April 1,” said spokesman Madeline Ziomek. “We hope that ProMedica will step up for patients and reconsider their decision to leave our network.”
ProMedica is the largest hospital system in northwest Ohio with 11 hospitals and a large group of about 1,300 salaried physicians and advanced clinical practitioners. Revenue was $3.3 billion in 2023.
Bloomfield, Conn.-based Cigna is one of the largest health insurers in the United States with 2023 revenue of $195.3 billion.
ProMedica sent 7,000 letters to Cigna members earlier this year notifying them that a rate dispute with Cigna could jeopardize their coverage with the system’s hospitals and doctors. The deadline for a new contract was April 1.
In a statement, ProMedica spokesman Tausha Moore said the system has been negotiating with Cigna for months to try to come to an agreement.
In fact, the system and insurer 15 months earlier had avoided a similar cutoff of coverage for Cigna commercial customers by extending a contract that had been set to expire in December, 2022.
“If Cigna had come to the negotiation table with reasonable and competitive terms that reflect the current realities of health care, we would not be in this situation,” Ms. Moore said. “The fact of the matter is that health systems must have reasonable contracts with payors if they are to deliver high-quality care — reimbursements must cover our rising equipment, pharmaceutical, and staffing expenses.”
She said ProMedica is open to further negotiations if Cigna is willing to be reasonable on rates. Cigna enrollees and patients affected by the termination of coverage can get additional information at www.promedica.org/cigna.
New rate contracts between hospitals and insurers typically are for three or four years.
Hospitals and insurers are increasingly colliding over rates in an era of rising healthcare costs for everything: labor, supplies, and services, said Larry Prybil, a healthcare professor at the University of Kentucky who previously managed Catholic health-care systems.
And patients are caught in the middle, often having to find new physicians and hospitals at their most vulnerable when these types of impasses result in contract terminations, Mr. Prybil said.
“It’s stress on top of stress,” he said.
First Published April 1, 2024, 9:14 p.m.
