On May 30, health insurer Cigna ended its contract with Virginia-based Mary Washington Healthcare. The reason it states is a failure of the two parties to come to terms on charges and reimbursements. This decision forces about 15,000 Cigna members in the Fredericksburg area to either find other providers or pay higher out-of-pocket charges.
On the Mary Washington side, Vice President Eric Fletcher says that Cigna’s proposal involved reducing its payments for hospital services by a startling 30%. In the wake of COVID-19-related financial blows and new vaccination clinic expenses, this was a concession Mary Washington couldn’t make. For Cigna’s part, its senior communications adviser claims that Mary Washington was demanding higher rates that would make care unaffordable for Cigna customers.
For our part, we just don’t know who to believe. Actually, we do. After more than a year of pandemic-related challenges, many hospitals and healthcare systems are struggling to stay afloat, while insurers have racked up record-breaking profits. So, whose story sounds more reasonable? The financially strapped healthcare system that’s had its resources stretched thinner than ever and can’t afford such a huge rate cut—or the cash-rich insurer who somehow can’t seem to find a way to make a deal?
Of course, the people who will feel the effects of this breakup most are the patients whose care has essentially been cut off. In the pandemic era, when adversity is costing millions of people their health, their livelihoods, and their savings, we’d like to think that insurers would follow the examples set by frontline healthcare workers and prioritize the healthcare needs of their members. Instead, it’s another case of prioritizing profits over people, just like when United Healthcare couldn’t manage to make a deal with Envision Healthcare at the start of 2021.
Let’s review what we’ve learned from all this.
Providers: Don’t expect insurers to share the wealth (or even goodwill) as we all move forward through this stage of the COVID-19 endgame.
Employers: Choose your insurers and plans carefully as open enrollment approaches. Consumers: When it comes to your health insurance, hope for the best, but plan for the worst.
And insurers: If you’ve actually read this far, well done. The next step is up to you. Go on, surprise us!