Category: Medical

Story updated with response from Cigna. See bottom of story.

Note that both sides agree that patients will still be able to get emergency care at Tenet facilities at Cigna’s in-network rate.

Health insurance company Cigna is threatening to drop Tenet Healthcare hospitals from their provider network. West Boca Medical Center and Delray Medical Center are both Tenet hospitals.
By a letter dated March 26, 2014, Cigna informed customers of discussions between the two companies, and stating that Tenet hospitals will no longer be in the Cigna network at the end of May if no agreement is reached. Cigna uses language suggesting that Tenet ended their contract early, is seeking higher rates, and will be leaving the network. Tenet claims that Cigna is attempting to reduce previously agreed rates.
The two companies last announced an agreement in July of 2012 that became effective in May of 2013.
West Boca News reached out to both sides Tuesday. Cigna has not responded yet and we did not find anything on their website about the dispute. Tenet responded with the following statement:

We have been negotiating with Cigna for new contracts covering the care our hospitals provide to Cigna members. If an agreement is not in place by June 1, 2014, access to our hospitals could be affected for Cigna members.
In our previously signed contract, Cigna agreed to payment rates for the care our hospitals provide its members. However, Cigna then changed its course and proposed a reduction to our previously agreed upon rates. We need fair payments from insurance companies to recruit and retain top physicians, invest in technology, and maintain our facilities at the level you have come to expect. These factors allow us to provide quality care. We are disappointed that Cigna has taken this position in our negotiations.
While we continue our negotiations to preserve patient access, it is important to know that prior to June 1, nothing changes and Cigna members can still come to our hospitals for healthcare services. Regardless of what happens with our network status, Cigna members can always access emergency care through our hospitals’ emergency rooms.
Cigna members with questions about their coverage should visit www.protectmyaccessfl.com or call (866) 966-3680.

Tenet Healthcare Corporation (NYSE: THC) has over 100,000 employees and over $11 Billion in revenue in 2013. They operate 189 outpatient centers and 77 hospitals including West Boca Medical Center and Delray Medical Center. WBMC is the closest hospital to most of our readers and is known for its pediatric emergency room. DMC is the trauma center for patients from West Boca, and recently treated the victims in the Jimmy the Greek stabbing. Wikipedia notes that Tenet has earned various awards including “214 CIGNA Quality Designations.”
Boca Raton Regional Hospital, an independent not-for profit, is not part of Tenet. BRRH is the next closest hospital after WBMC and is currently in Cigna’s network of commercial plans, but not for Cigna Medicare plans.
Cigna (NYSE: CI) has over 36,000 employees, approximately 75 million customers and over $32 Billion in revenue in 2013. Their main business is health insurance offered in all 50 states, other US territories, and a number of other countries. The company made news yesterday after announcing they had signed up 75,000 to 100,000 people in “Obamacare” plans in five states including Florida. At this time it’s unclear whether the Affordable Care Act plans will be included in BRRH’s network.
Update April 2, 12:30 pm:
Cigna responds:

Regarding your story about Cigna and Tenet, the assertion that Cigna is threatening to drop Tenet Healthcare hospitals from our network is not correct. In fact, it’s the other way around.
Cigna was notified by Tenet Corporation of its intent to leave the Cigna network as of May 31, 2014. We are in active negotiations to try to reach mutually acceptable terms on a new contract. While the specific terms of the contract and negotiations are confidential, I can say that we remain far apart on multiple issues of critical importance to our customers and their employers – issues that impact the future cost and affordability of care from these health care facilities and professionals.
We are willing to continue negotiations and would welcome Tenet facilities and physicians to remain part of our network. However, we have an obligation to protect the interests of our clients and customers and ensure that they have access to high-quality doctors and hospitals at a competitive cost, both now and in the future.
We hope to continue our relationship with Tenet and are willing to continue negotiations. However, if an agreement is not reached by May 31, 2014, then any claims for non-emergency services provided by Tenet facilities and affiliated employed physicians after that date will be processed according to an individual’s out of network benefits, if their plan includes coverage for out of network facilities and health care professionals.
In an emergency, customers can use any nearby facility and still be covered at the in-network level.
We are also actively working to minimize disruption and will offer “continuity of care” benefits to our customers who are in the middle of treatment. This will enable them to continue that treatment until arrangements can be made for a safe transfer of care to another hospital or doctor.
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We will make every effort to accommodate people who are under the active care of a Tenet facility or affiliated physicians for one of these situations. We encourage any customer who has questions to call the customer service number on their Cigna ID card; our service team is available to help and answer questions 24 hours a day, seven days a week.