About 5,000 patients insured by Cigna Healthcare will find themselves out of network come Oct. 1 when they go to any hospital or clinic operated by St. Charles Health System.
For several years the health system has asked insurance companies to adjust contract language that addresses denials and coverage for medical treatment, said Alandra Johnson, St. Charles Health System spokeswoman. The goal was to shift the administrative responsibility from the health system back to the insurance companies.
Cigna Healthcare and the Central Oregon health system reached an impasse on negotiating the terms. Notices were sent out to patients carrying this insurance last week notifying them that as of Oct. 1, they would be considered out of network. That means discounted rates, and pre-negotiated rates will not be passed on to patients. When patients see an out-of-network provider, costs can be higher or an insurance provider may not cover care at all. Patients can also be subject to different deductibles.
“Our goal is to find common ground with insurers to address inefficiencies and wasteful processes within our overly complicated payment system that add costs for everyone, especially patients,” Johnson said. “We’ve made strides and found common ground in most of these conversations, but not all.
“We truly regret the challenges this may present to (patients).”
For Kyle Swenson, a Bend resident, the change directly affects the post-operative care following his planned shoulder surgery at the end of the month. Swenson and his wife are also planning to have a child. What happens when is wife goes into labor, he asked?
While he has options, none of them are cost effective.
“It seems very unfair,” Swenson said. “No one is thinking about the people who need the health services. It seems that it’s just about the money.”
It’s not the first time that the health system has dropped accepting certain kinds of plans. In 2023, St. Charles dropped some Medicare Advantage plans for a similar reason.
Insurers delaying tactics and denying claims are disrupting patient care, said Lisa Goodman, Hospital Association of Oregon spokeswoman.
“The friction we’re seeing between insurers and providers is a symptom of Oregon’s broken health care system, which needs to keep patients at the center,” Goodman said. “This is a serious issue that affects all Oregonians, as it delays patient care, adds unnecessary costs to both patients and providers, and puts additional strain on our struggling hospitals.”
Federal laws prohibits health care systems that operate an emergency department from turning away patients, regardless of their ability to pay, said Timothy Heider, an Oregon Health Authority spokesman. Cigna patients could still seek treatment at St. Charles emergency departments, he said, and it would be covered. Statewide there are 18,163 people who were receiving health insurance from Cigna, said Heider, citing data from June.
Cigna Healthcare said they received notification from the health system. St. Charles operates four hospitals in Central Oregon. The next closest hospital is Providence Memorial Hospital in Hood River, or Klamath Falls.
“St. Charles Health System notified us of their intention to leave the Cigna Healthcare network,” said Jocelyn Parker, Cigna Group enterprise media relations lead and senior advisor. “We have a positive relationship with their quality caregivers and we want them to stay in our network, but hospital leadership is making unreasonable demands that would make care much more expensive for the people we both serve."
Most of the patients affected are on employer self-insured health plans where the employer pays for employees medical claims instead of buying a fully insured plan from an insurance carrier, Parker said.
“That means any increase in cost of care is paid directly by local employers, their employees and their families,” Parker said. “We will continue to negotiate with St. Charles to reach a fair agreement that will keep them in network.”
