Cigna Letter
The letter seen here was recently sent out by Cigna in response to Floyd Memorial and Cigna being unable to reach agreeable terms in negotiation.
This letter is in extremely poor taste as it characterizes physicians as being in breach of the contract.
Let’s begin with the second sentence: “The basis for the termination is your failure to have admitting privileges at a CIGNA HealthCare participation facility.”
First off, every physician who received this letter had privileges at CIGNA HealthCare participation facility until Cigna reneged on their agreement with Floyd Memorial and allowed their contract with Floyd Memorial to expire.
Physicians were not involved in the negotiation, consulted about the process, or informed about the outcome until it was already terminated. So to say physicians “failed” is just wrong and extremely biased.
The next sentence “However, we value your participation in the CIGNA HealthCare provider network and would like to know whether you have admitting privileges at any CIGNA HealthCare participation facility or plan to seek privileges and until you get privileges, what are your hospital admission plans so that CIGNA HealthCare may allow you to continue your participation in the CIGNA HealthCare provider network under the most current Managed Care Agreement between you and Connecticut General Life Insurance Company.”
Again, the wording is extremely distasteful and appalling. If they valued our participation, we would have been involved in the process. They know by our agreements if we have privileges at other hospitals. They act as if it is some great honor to be a member of their network.
Because of their failure to negotiate a contract with Floyd, they now want physicians to disrupt their routines and obtain privileges at another facility. Practicing at an unfamiliar hospital is neither beneficial nor time-efficient for the patients or physician. It potentially affects quality of care and may lead to increased complications.
Patients and physicians should be outraged by the tone of this letter as well as the arrogance of Cigna.
It is not physician’s responsibility to provide an adequate provider network for the insured patients. This is the sole responsibility of Cigna. Their failure to maintain an adequate provider network for their insured customers is, in my opinion, a breach of their contract with the employers and the patients themselves.
I hope physicians understand what this letter is really saying and the tone in which it was written.
posted by Anonymous at 6:25 AM
16 Comments:
HB, it sounds to me that the word "failure" is likely being used because the letter is referring to the particular contract term that is the basis for the termination action.
I don't think it can be delineated that it is Cigna's fault, or FMH's fault the contract was not successfully re-negotiated. It takes two to agree; it is both their faults.
But the facts are as posted in an earlier posting. Both parties had a verbal agreement with the contract language, fees, etc. and without warning, Cigna reneged on the verbal agreement.
I agree it is business, but the letters Cigna issued and what the newspaper published gave no indication of this.
Physicians had no part in any of it. They did not fail in keeping up their part of their contract.
I guess you now know how your patients felt when you sent out the letter saying you are no longer going to honor their Insurance Carryor, ie: Aetna, and United Healthcare, and the rumor is that there are more to come!!!!
I find it hard to believe that anyone in the Healthcare Business relys on verbal agreements. The 1st rule in any business transaction is "get it in writing".
Just ask Judge Brown or Judge Judy.
No one relies on verbal agreements in this business, but as a preliminary working relationship, you would hope their word is somewhat good.
If we did what Cigna did, our patients would have recieved their first notice with a letter saying something like:
Dear Patient,
Due to your failure to maintain appropriate insurance coverage, we can no longer see you as a patient. But we value our relationship and if you now jump through these hoops, we may feel sympathy and allow you to continue coming here"
A little sarcastic, but very similar to the letter Cigna sent the physicians.
We posted notices months in advance and sent letterw weeks in advance to our patients and have offered to work with each one of them.
I do believe there is some differences in the manner these things were handled
I am a FORMER PATIENT of PA no one EVER offered to work with me the only said I could still come to PA and be out of network thus costing me $400.00 PLUS 20% of the bill (80-20) thanks and you STILL haven't answered were the 20% goes after UHC pays thier part!! I bet it is a 20% increase in your pocket. Thats really taking care of patients I believe it is taking care of DE.
For the PA pt.
You should have recieved a letter explaining the details. You are more than welcome to call and talk to any of our staff and they will explain it more clearly.
I can assure you it will not be as you describe. It will only take one phone call and Laura is the Billing manager.
In essence isn't that what your letter implied. I believe it stated you can continue to come to our office but it will be under our terms. Your patients did not have any imput in your negotiations with their Insurance Company and I have it from a very reliable source that one of your Associates was the 1st. one to walk out on talks between the Doctors and Insurance representives. Seems to me like their is double standards. As the saying goes "Whats good for the goose is good for the gander".
You certainly are entitled to your opinion, but it is factually inaccurate.
Why don't you post the letter and allow the readers to see the difference.
Our letters and willingness to work with patients is far different than any of these insurance companies.
What is your bias in all of this?
Keep up the good work. I've worked in Healthcare 25 plus years and it's great to see someone support the staff! I am not anti-administration but feel that they are not in the real world of patient care. Yes, I can sat in an office and tell you how patient care should be in an ideal situation but how often does this occur? The Staff is the backbone of any facility and administration needs to listen to them.
Why don't you post your own letter.
I am sure you kept the original. It was easy for you to post Cigna's. I have no bias, as I said it seems like there is a double standard. I can see I must have touched a nerve. It seems like there appears to be a fight, and unfortunately the Patients are being squeezed in the middle, by Doctors that want to make more money and Insurance Companies that do not want to pay. I suppose you might think there is bias, but as I see it the Patients and also Doctors are going to lose in the end. Patients will go where their Insurance dictate. People would be foolish to do otherwise. It might be an inconvenience to choose another Doctor and Hospital but if
faced with the issues that now prevail that might be their only alternative. If you feel that you were justified in terminating Aetna and UnitedHealthcare that is your right, but I stand with my statement, your patients had no choice when you negotiated with the Insurance Companys and opted out of their Network.
anonymous, your statements are again inaccurate.
Patients were given prior notice in ample time along with the major employers before this was finalized. Patients do have a choice and they can continue to see us. We have made it easy at our office.
I began posting on United around March and these can be reviewed any time. Anyone wanting a copy of the letter can email me and I will be happy to send one.
Your comments and anonymity show clearly your bias even if you won't admit it.
What is really sad is that patients, the consumers, feel they have no choice. That is the biggest issue in all of this. Why do employees continue to hold their employers guilt-free?? We do have choices and one of those is to pressure our employers to offer us other plan options and also to pressure our government to return healthcare control to the individual consumer and not the employer. By the way, I just received notice my individual health insurance policy price was increasing next month by 15%. Wonder whose pocket that will be going in?
I can assure you it won't be the physicians.
The bottom line on this letter from Cigna is that Cigna could have allowed all the physicians to remain as providers even though Cigna dropped Floyd Memorial.
If patients were their primary concern, it would not have cost them to keep the physicians. Their contract didn't change.
Their motive, in my opinion, was to get doctors upset in order to put more pressure on Floyd to accept the poor hospital contract.
When you start to play Hard-Ball with Insurance Companys, why cry when they decide to join in the game. It takes 2 to play but there is only going to be 1 winner. In this case there will be 2 losers, one that didn't get to play and 1 that did. I will let you in on 1 loser-PATIENTS-you can choose the other.
Anonymous needs to get their own blog and belly ache about her lack of knowledge in the way physicians are being treated by payers. Maybe when she beefs up on what is really going on in healthcare in that the payers are lining their own pockets and taking reimbursment away from the people providing the care, anonymous might get some respect on their statements. Currently they just sound like they are very mis-informed. Give us a break and stop ranting about how dumb you really are anonymous! What a jerk.
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