SkyRidge, Cigna are willing to negotiate
by DAVID DAVIS, Managing Editor
Aug 04, 2013 | 2344 views | 0 0 comments | 13 13 recommendations | email to a friend | print
The parent company of SkyRidge Medical Center and Cigna, one of the top three health insurers in Bradley County, both say they are open to negotiating a new contract that would return the local hospital to the Cigna network.

The contract between Community Health Systems and Cigna expired June 30.

All hospitals in Tennessee owned by CHS were removed from the insurer’s list of network providers.

CHS owns 11 hospitals with 1,490 beds in the state, according to the company website.

Of those, SkyRidge is the largest with 351 beds followed by Gateway Medical Center in Clarksville with 270 beds and Dyersburg Regional Medical Center with 225.

Pam Nelson, owner of Ocoee Insurance Services, who brokered the plans available to about 620 Bradley County employees, said Friday the impasse between CHS and Cigna mirrors that of BlueCross BlueShield and Memorial Health Systems in 2012.

She said such negotiations between insurers and providers are typical.

“I see it all the time, but it is usually seamless and no one ever knows about it,” she said.

“In this instance, it has taken a little longer, but I’m confident they will reach an agreement because it’s in the best interest of everyone.”

The several thousands of Cigna policyholders in Bradley County may go to SkyRidge. In emergencies, claims would be paid at the network level. In non-emergencies, policyholders would pay larger out-of-pocket expenses, depending on the health plan and services performed.

Nelson said the loss of SkyRidge as a network provider has no bearing on the contract with Bradley County.

“It has nothing to do with Bradley County,” she said. “The contract does not guarantee a particular doctor or facility will be in the network. It guarantees a level of benefits will be available.”

CHS spokesman Tomi Galin said Friday in an email, “We remain open to reaching a resolution with Cigna. While they are out of Cigna's network, our affiliated hospitals are working with patients covered by Cigna to minimize the financial impact (of out-of-pocket expense). Providing services to patients and communities remains their primary focus, and they accept most other major health plans in their markets.”

Cigna public relations spokesman Amy Turkington said the insurance company opened discussions in the fall of 2012.

She said Friday in a telephone interview that it is her understanding there are no active negotiations with CHS.

“We have been willing to negotiate an agreement, but Community Health Systems chose to terminate the participation of all of its hospitals and employee medical groups in Tennessee,” she said.

“They chose to leave our network. We did not reach agreement on a new contract by the time our existing contract expired.”

Turkington said Cigna would like to reach an equitable agreement with CHS, “but we also have an obligation to our customers to ensure they have access to high quality care at a competitive cost.”

She said the majority of Cigna customers in Tennessee are employers who self-fund their plans, which means Cigna is providing administrative services such as claims administration, health and wellness programs and customer service.

Employers and employees are actually paying the cost of claims through copayments, deductibles and co-insurance.

“If any health care provider or facility asks for an increase in cost, employers and their employees would see an increase in cost if we were to agree,” she said. “We know that our clients and customers are concerned about the increasing cost of health care. They would be the ones to see the increase in cost if we agreed to those terms.”

She said notification was sent to Cigna customers so they could provide for “continuity of care benefits.” Those benefits allow people to get care from health care professionals outside the network until a transfer of care is arranged.

“Some examples are recent major surgery or acute conditions that were in active treatment, such as a heart attack, stroke or pregnancy in the second or third trimester. Those continuity of care benefits have been available to our customers.”