“Cigna’s refusal to fairly reimburse Mercy Health while simultaneously bringing in significant profits — paid for by patients and employers — is incomprehensible,” said Joseph Morman, chief clinical officer at Mercy Health - Springfield Regional Medical Center.
Debates over costs
A Cigna Healthcare spokesperson said it is disappointing that Mercy Health is choosing to go out of network due to Mercy Health “demanding unreasonable rate hikes” for its employer-sponsored plans.
Almost all of Cigna’s employer clients’ benefit plans are self-funded, which means increases in the cost of care are paid directly by local employers, their employees and their families, a Cigna spokesperson said.
Cigna is continuing to negotiate with Mercy Health to reach a fair agreement that will keep health care affordable for patients, the spokesperson said.
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.
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%.
Credit: Nick Graham
Credit: Nick Graham
On the opposite end, Mercy Health’s parent nonprofit, Bon Secours Mercy Health, has been struggling with operating losses.
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.
April 1 deadline
Patients with a Cigna commercial plan can continue to see their Mercy Health providers through Monday . 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.
“We urge patients to call Cigna at the number on the back of their insurance card to let them know how important it is to keep Mercy Health in its network,” Morman said.
Credit: Nick Graham
Credit: Nick Graham
Should Mercy Health go out of network, all patients will have access to care in the event of an emergency, the hospital said.
Some patients may qualify for continuity of care exemptions that would allow them to maintain in-network cost arrangements. Cigna alone will decide whether to approve or deny the request, Mercy Health 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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