Main Line Health Considers Leaving Cigna Network: What This Contract Dispute Means for Patients

Overview:

Main Line Health, a Pennsylvania-based nonprofit, may end its contract with Cigna if both parties can’t agree on terms by February 15. This situation could leave many patients without an in-network provider.

In a notice to patients, Main Line Health explained that Cigna’s rates for reimbursement are lower compared to other nearby health systems. These rates have not changed since 2016. Main Line Health is seeking higher reimbursements to accommodate rising operating costs, particularly increased labor expenses and inflation.

Cigna, on the other hand, stated they are negotiating in good faith with Main Line. They claim to have a wide network of providers ready to assist patients if an agreement isn’t reached.

Current Situation:

This conflict illustrates a larger trend: many healthcare providers are facing challenges during contract negotiations. Recently, several systems across the country have threatened to leave their networks. The providers argue that their reimbursement rates from insurers are not keeping up with the increasing costs of healthcare.

For instance, some health systems in the Midwest have cut their Medicare Advantage offerings for 2025 due to reimbursement struggles. Allina Health and MyMichiganHealth have recently ended contracts with Humana and Aetna, respectively. Likewise, Essentia Health has also separated from both Humana and UnitedHealthcare.

Insurers argue that their rates align with industry standards, which helps keep premiums lower for consumers. However, Main Line Health argues that it is overdue for a renegotiation. They express concern that while Cigna has made substantial profits in recent years, they have had to deal with fluctuating operational costs.

A spokesperson from Main Line Health stated, “We must have fair reimbursement that covers the cost of the care we deliver.” This highlights the tension between costs and compensation in the current healthcare landscape.

Hospital price transparency laws have added an extra layer to these negotiations. While providers have long suspected underpayment compared to their peers, new laws require hospitals to publicly post their negotiated prices. This transparency helps providers negotiate better rates.

For instance, last spring, Mount Sinai Health System used this price transparency data in its contract talks with UnitedHealthcare, which nearly resulted in a contract termination.

As the deadline approaches, Main Line Health and Cigna have a short window to finalize an agreement. This will determine whether Cigna remains an in-network option for Main Line’s hospitals and outpatient facilities, including Lankenau Medical Center and Bryn Mawr Hospital.

Discussions around contract negotiations are important, but they do not guarantee that providers will exit their agreements with insurers. Many health systems, like Mount Sinai and Providence, have warned patients before reaching new agreements, highlighting the unpredictability of these negotiations.