SARASOTA, Fla. (WWSB) - Thousands of people are being affected by the split between Sarasota Memorial Hospital and Cigna Health Insurance.
Hospital representatives have confirmed to ABC7 that they ended their contract with the insurance network after more than two decades. The communications specialist for SMH, Kim Savage, says they didn’t part ways with Cigna Health because of rates. She says it was about provisions in their contracts relating to unjustified claim denials and coverage decisions that impact the ability of patients to access essential care.
Savage says the hospital requested that Cigna Health exclude ‘Limited Benefit Plans’ from their contract.
“Limited Benefit Plans were not developed to be primary health insurance plans. They offer only minimal coverage and few protections to patients,” said Savage.
She says patients with those health plans often find out their plan is not what they were expecting when they’re denied hospitalization and essential care coverage.
“We believe SMH is using an isolated and easily solved aspect of our negotiation to deny affordable access to Cigna customers,” said Holly Fussell with Cigna in Florida. “The contractual item that SMH continues to raise is isolated to only one third-party administrator. We offered a compromise on this issue but unfortunately SMH rejected it.”
Cigna representatives say the dispute wasn’t only about contractual terms but also about reimbursement rates.
“Sarasota Memorial wants to dictate which Cigna clients can have access to their hospital and physicians group,” said public relations representative for Cigna in Florida, Holly Fussell.
She says clients could be paying for services that are not covered under their benefit plan because SMH is refusing to provide itemized bills. Fussell says SMH is refusing to allow Cigna to perform pre-payment claim reviews.
“We talked through proposals put forth by both sides. In the end, however, neither Cigna nor SMH were able to reach a mutually acceptable compromise,” said Savage.
SMH says during the past year they’ve notified more than 15,000 people who have used Cigna at the hospital in the last two years or a doctor in a SMH First Physicians Group practice about the situation.
The current agreement between SMH and Cigna ends on April 30. The split also included doctors under First Physicians Group.
No extensions will be made. The hospital says patients undergoing chemotherapy, in second or third trimester of their pregnancy or undergoing a hospitalization can request an authorization from Cigna to receive continuing care from SMH and First Physicians Group at an “in-network level.”
DECEMBER 2019: After working for nearly a year, Sarasota Memorial Hospital says contract negotiations with Cigna insurance are at a standstill.
The contract between the two health care giants is set to expire on December 31, 2019, but thankfully, the hospital has agreed to extend their existing contract one final time until April 30, 2020.
However, in a statement the hospital calls this the “last extension” and says it agreed to provide is “so that people have time to transition to a new health plan, or if necessary, a new provider.”
The hospital stated:
We value our insurance partners and work diligently to maintain agreements with more than two dozen providers in this region. Every few years, we collaboratively review and update those agreements. We have given Cigna ample time to work with us on a new contract - and several extensions - but the insurer refuses to agree to standard provisions that are necessary to protect patients and the health system from unfair claims denials and coverage decisions impacting patients’ ability to access care. These basic protections are included in our contracts with other major insurance partners.
If the hospital and Cigna do not reach an agreement, it will affect hundreds of people on the Suncoast, including nearly 700 City of North Port employees.
The hospital has provided this website for those who have additional questions and to provide a list of insurance companies that the hospital has agreements with.