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Cigna, Mary Washington Healthcare sign new agreement
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Cigna, Mary Washington Healthcare sign new agreement

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Doctors, hospitals and other facilities associated with Mary Washington Healthcare will rejoin the Cigna network on Dec. 1, ending a split that will have lasted for six months and resulted in higher, out-of-network costs—and equally high measures of frustration—for the 15,000 Cigna customers in the Fredericksburg region.

The multi-year agreement was announced Monday afternoon by Cigna and the Mary Washington Health Alliance, which includes Mary Washington Hospital, Stafford Hospital, a third emergency room at Lee’s Hill, 40-plus outpatient facilities and more than 500 physicians.

Little else was said in brief press releases each company distributed. Representatives noted how pleased they were to be back together and to continue to offer the care for which they’re known.

Marketing people at neither company would say how long the new contract lasts or what compromises were made to reach it. The tight-lipped approach is a far cry from this spring, when Mary Washington claimed Cigna proposed reducing its payment for hospital services by almost one-third and Cigna said Mary Washington demanded rates and increases that were too high for its clients.

As a result of the disagreement, the contract between the two parties ended May 30. Cigna customers have either paid out-of-network prices to continue seeing the same doctors and getting services such as physical therapy and X-rays locally through Mary Washington’s expansive network or they’ve traveled to Culpeper or Charlottesville, Richmond or Northern Virginia to visit other in-network physicians.

Ryan McGill, a King George County resident and Fairfax County firefighter, encouraged the two parties to keep negotiating from late spring to early fall. He’s a leader with the union that serves professional firefighters and paramedics in Fairfax. About 200 of them, along with another 200 Fairfax County workers, live in the Fredericksburg area and have been affected by the contract dispute.

McGill organized a rally in August and continued to check in with Mary Washington Alliance leadership weekly or every other week. He thanked the alliance and Cigna for continuing to work together until a deal was struck.

“We’re happy,” he said. “It took longer than what we wanted, but obviously we’re happy with the outcome.”

However, he did express some concerns about the fallout.

“We are seeing one of the largest premium increases we have ever seen, nearly a 30 percent increase” for next year, McGill said. Fairfax County is self-insured and sets its own premiums for health insurance.

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Also, McGill said he’s concerned that Fairfax workers and others covered by Cigna could face a repeat of this contract dispute when the current agreement ends.

“In the next couple years, we could be right back where we are,” he said.

In addition, the new agreement doesn’t erase the frustration felt by clients who have tried to find new doctors within Cigna’s network after the contract lapsed. Some, such as Spotsylvania County resident Drew Gallagher, searched locally for other providers, only to discover that many practices had been taken over by Mary Washington.

“The MWHC footprint is far bigger than it had been just two years ago,” he said this summer.

Others who had procedures or doctor visits with their same providers faced exorbitant bills. Wendy LaRue of Fredericksburg had an endoscopic ultrasound—to look at the organs in the chest, abdomen and colon—two days after the Cigna–Mary Washington contract ended. She has what she calls a “Cadillac Cigna plan” and is well-versed in reading the fine print.

She had called Cigna in advance and understood that her out-of-network benefit would cover all but about $1,500 of the cost, she said.

“You can imagine the shock when I received bills for more than $10,000,” she said.

LaRue spent at least 12 hours on the phone with Cigna representatives to dispute the costs. The hospital portion of her bill was reduced from more than $8,000 to about $650. She’s still waiting to hear the fate of her appeal on the anesthesiologist’s bill, which either will cost or save her more than $1,100.

“What good are out-of-network benefits if you are still facing tens of thousands of dollars in expense?” she asked, adding that she’s fortunate she knew how to advocate for herself. “I feel really bad for people who don’t have that level of knowledge or the ability to spend hours on the phone.”

When asked if services provided to Cigna customers by Mary Washington facilities would be covered retroactively, Holly Fussell, Cigna’s senior communication advisor, said they wouldn’t. However, she said many services were still considered in-network due to a clause called continuity of care, which allows some patients to continue seeing the same doctors if they have acute or high-risk cases such as cancer treatments or pregnancy.

Fussell said the authorized continuity of care benefits will have lasted from May 31 to Nov. 30, even though Cigna’s website says such care is usually authorized for just 90 days. Fussell also said, “Cigna worked hard to contract directly with the majority of Mary Washington providers to continue providing in-network care to customers.”

Cathy Dyson: 540/374-5425

cdyson@freelancestar.com

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