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Main Line Health says Cigna hasn’t updated its reimbursement rate since 2016. Cigna says it is negotiating in good faith to find a solution that keeps healthcare affordable for patients.
The dispute between Main Line Health and Cigna comes as payer and provider contract negotiations have grown increasingly contentious.
In recent months, a significant number of providers have threatened to go out of network during contract negotiations — and some have ultimately jumped ship — over claims that payers’ reimbursement rates do not keep pace with the rising costs of care.
Several Midwestern systems, for example, culled their Medicare Advantage offerings for 2025, citing challenges with reimbursement and prior authorization. Allina Health dropped Humana, MyMichiganHealth axed Aetna and Essentia Health parted ways with both Humana and UnitedHealthcare.
Insurers, on the other hand, argue the rates are in line with industry standards and keep premiums lower for consumers.
In the case of Main Line Health, the system said the current contract negotiations with Cigna — which impact all the insurer’s commercial products — were “overdue” in a statement to Healthcare Dive. Main Line said that, while Cigna has recorded billions in profits in recent years, the health system has incurred losses associated with rising operating costs.
“We must have fair reimbursement that covers the cost of the care we deliver,” a Main Line Health spokesperson said.
Hospital price transparency laws are in some cases intensifying contract renegotiations, according to a report from the New York Times.
Although providers may have long suspected they are under reimbursed relative to peers, they’ve had few avenues to prove it. The advent of price transparency laws in 2021 — which require hospitals to publicly post negotiated prices for certain services, broken out by insurer — has offered them ammunition.
For example, last spring New York-based Mount Sinai Health System leveraged price transparency data in its tense contract negotiation with UnitedHealthcare, according to The New York Times. Mount Sinai narrowly averted going out of contract with the insurer in March.
Main Line Health and Cigna have a little over two weeks to come to terms that would keep Cigna an in-network option for Main Line’s four acute care hospitals — Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital —Bryn Mawr Rehab Hospital and the system’s outpatient facilities.
Publishing details about contract negotiations does not mean the provider will ultimately go out of network with the insurer.
Last year both Mount Sinai and Washington-based Providence posted details about ongoing contract negotiations and warned patients they could lose insurance coverage before ultimately signing new contracts with payers.
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The Biden administration is attempting to push through a slew of reforms to the controversial MA program in its final months in power, though it will need the Trump administration’s buy-in to get them across the finish line.
Donald Trump’s first term as president was characterized by significant turbulence for government healthcare programs. Here’s how some of the most influential industry groups responded to the Republican’s reelection.
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