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Dive Brief:
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Main Line Health may be the next health system to go out of network with a major insurer if the Pennsylvania-based nonprofit and Cigna cannot agree to contract terms prior to Feb. 15.
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In a notice to patients, Main Line Health said Cigna reimburses the health system at lower rates than nearby health systems and uses rates set in 2016. The health system is asking for reimbursement hikes that it says reflect increases in operating costs, including higher labor costs and record inflation.
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Cigna told Healthcare Dive the insurer is working “in good faith” with Main Line to find a solution that keeps healthcare affordable for patients. However, the insurer said if the health system ultimately chooses to go out of network they have a robust system of providers in the area that can accept Main Line patients.
Dive Insight:
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.