Patients could suffer as Cigna, UMC battle

The April 1 letter to tens of thousands of Southern Nevadans covered by Cigna health insurance did not contain good news: “Please be aware that effective April 30, 2013, University Medical Center ... will no longer be a participating hospital in our network.”

Sounds pretty clear, doesn’t it? Particularly when that announcement is followed up by information that makes it even more clear that, starting next month, you’ll pay a lot more if you go to a UMC Quick Care or to a primary care or speciality physician who admits only to UMC: “Services performed after April 30, 2013, will be considered out-of-network.”

Cigna officials say that “approximately 90,000 individuals could potentially be impacted.”

And yet chances are better than good, say those in a position to know, that in May, people insured by Cigna will be covered for UMC medical services.

Confused?

Welcome to the world of multimillion-dollar contract negotiations in health care, where innocent consumers end up worried and stuck in the middle. Or as Lisa Swirsky, a Consumers Union senior policy analyst puts it, “When two elephants fight, the grass suffers.”

There is no question that UMC believes Cigna started a public fight to help it force the hospital into accepting lower reimbursement rates from the insurer for hospital services.

Present UMC patients and future patients have been calling the hospital about whether they should switch to another provider, UMC officials said Wednesday. A worried woman who said she was hoping for a kidney transplant at UMC called the Review-Journal on Wednesday asking for guidance.

Rose Coker, director of managed care and business development for UMC, said: “I feel that (letter) was sent out just to put pressure on UMC. We were shocked when those letters went out.”

Cigna’s Amy Turkington said in an email, however, that with no new contract hammered out and the current contract coming to an end at the end of April, the insurer had a duty to notify its customers “about this potential change so that if an agreement is not reached, we can help minimize disruption.”

Coker said that duty would have been necessary if Cigna’s chief negotiator, John Prassas, had not been granted what he said he needed: an extension for contract negotiations.

“Our CEO (Brian Brannman) had the power to grant it last week, and he did,” Coker said. “And Prassas sent those letters out anyway.”

Turkington said the extension wasn’t received until the letters had already been sent out.

Prassas was unavailable for comment.

Brannman noted that Clark County commissioners, who oversee UMC, were informed of his action extending negotiations during Wednesday’s commission hearing.

“We have no intention of stopping doing business with them (Cigna),” Brannman said.

In her email, Turkington said the insurer is “hopeful an agreement will be reached.”

Swirsky said Wednesday that her policy and action division of Consumer Reports, the activist publication that works for consumer protections, is no stranger to people being confused and sometimes misused by health care companies.

“In this case, prices weren’t negotiated that were wanted, and consumers got stuck in the middle,” she said. “And it scares the heck out of them. There is a definite lack of transparency for consumers about what’s going on.”

Brannman said the rates worked out by providers and insurance companies are “proprietary.”

The CEO noted, however, that rates must be negotiated on everything from emergency and quick care visits to surgeries. Insurance companies even dictate what appliances –– say, for a heart procedure –– will be covered, he said.

Cigna’s Turkington pointed out that, should a pact not be reached with UMC, the insurer will continue to cover “for a defined period of time” some customers who must receive services at UMC.

That would include people recovering from recent surgeries; patients with acute conditions in active treatment such as heart attacks and strokes; pregnant patients in the second or third trimester; people with newly diagnosed or relapsed cancer who are undergoing chemotherapy, radiation therapy or reconstruction; trauma patients; and transplant patients.

Turkington said Cigna customers with questions should call the customer service number on their ID cards.

Contact reporter Paul Harasim at pharasim@review
journal.com or 702-387-2908.