The insurance company that covers thousands of Metro employees could soon go out of network with one of the largest hospital systems in the state.
Cigna Healthcare and HCA Healthcare Tennessee have until Sept. 30 to nail down a contract. If they fail to, Cigna members will have to find new doctors for ongoing health care.
In a statement, outgoing Nashville Mayor John Cooper says his office has been in contact with both companies to advocate for a solution.
“This dispute between HCA and Cigna, if not resolved quickly, will impact tens of thousands of city employees, city retirees, teachers and others who work in government throughout Tennessee,” it reads.
Hospital systems don’t charge everyone the same rates for their services. Insurance companies negotiate pay rates with hospitals, and once they reach an agreement, the two organizations are considered “in network” together. Patients have to pay more out of pocket for services at hospitals that are not in network with their insurer.
These disagreements are somewhat common. The city of Memphis was* in a similar spot. Its insurer, Blue Cross Blue Shield of Tennessee, was in contentious negotiations with Methodist Health Care. The Commercial-Appeal reported 14,000 patients could have been affected. The two ended the dispute in June.
Insurance companies and hospitals have opposing needs when it comes to payments. Insurers usually say they need payments to be lower to save their members money on premiums. Hospital systems say they need payments to be higher because services are expensive to provide.
That’s the case with Cigna and HCA.
“We want to keep health care affordable for our clients and customers, especially as they are managing rising prices due to inflation,” a Cigna representative wrote in a statement. “Unfortunately, TriStar Health (HCA) is demanding significant rate increases that are substantially more expensive than other health care providers and will increase what people in Tennessee pay for their health care needs.”
HCA didn’t immediately respond to a request for comment, but they have an interactive page on their website with frequently asked questions about the contract negotiations.
“We want to continue our relationship with Cigna Healthcare,” one answer reads. “But it is critical that we are able to agree upon a reasonable contract that allows us to maintain access to quality care that our patients, physicians, leadership and staff have come to expect.”
If the two go out of network, Cigna members would have to pay significantly more for out-of-network services, but there are some exceptions. Emergency medical care would still be considered in network. Labor and delivery care will still be in network if the patient is at least 24 weeks pregnant as of Sept. 30.
The exception does not include urgent care or other non-hospital facilities like imaging centers.
State officials compiled some information about what will happen if the two companies go out of network, including a list of hospital facilities that would be affected:
- Parkridge Medical Center, Inc. – Chattanooga
- Parkridge East Hospital – Chattanooga
- Parkridge West Hospital – Jasper
- TriStar Ashland City Medical Center – Ashland City
- Tristar Horizon Medical Center – Dickson
- TriStar Hendersonville Medical Center – Hendersonville
- TriStar Summit Medical Center – Hermitage
- TriStar Centennial Medical Center – Nashville
- TriStar Skyline Medical Center – Nashville
- TriStar Southern Hills Medical Center – Nashville
- Tristar Stonecrest Medical Center – Smyrna
- TriStar NorthCrest Medical Center – Springfield
Correction: This story originally stated the dispute between BCBS Tennessee and Methodist was ongoing. The two companies resolved the dispute in June.
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