A contract rift between a major health insurance company and independent doctors has put thousands of Georgia patients in danger of big surprise bills from hospital visits, starting Sept. 1.
Many doctors who work in hospitals are independent contractors, but patients often don’t know that. The doctors have their own contracts with insurance companies, separate from the hospital’s. Last week the insurance company Cigna told ApolloMD, the state’s largest organization of independent doctors, that it would cancel their contract. That means a patient who walks into a hospital in his or her Cigna network might not have insurance to see the doctors in the hospital.
“At the moment we don’t know how many patients this will affect,” said Eric Swartz, ApolloMD’s lawyer who’s been talking to Cigna. “We’re looking at ways to protect them, to minimize the impact to the patients. That’s very difficult to do because we don’t know how Cigna’s going to treat them once we go out of network.”
ApolloMD doctors treated Georgia Cigna patients 23,000 times last year in emergency rooms alone. Cigna canceled the contract not just with ApolloMD’s ER doctors but with its anesthesiologists and hospital doctors as well, about 400 physicians.
Cigna said in a written statement that “Cigna is advocating for our customers and employers who deserve access to local, affordable, quality health care. Apollo MD wants to be reimbursed at rates that far exceed what is normal in our area. We would like Apollo MD to be in our network, but only on terms that are affordable for our customers and employers.”
ApolloMD officials responded that its rates with Cigna are competitive with those of other companies, and that ApolloMD doctors have gone some time without asking for rate increases even as costs around them rise.
Out of the blue, they said, after years under the same contract, Cigna earlier this year asked for a reduction of about 25% in rates the company was paying ApolloMD ER doctors. When ApolloMD pushed back, Cigna gave notice it would cancel the contracts for all three: ER doctors, hospital doctors and anesthesiologists.
“For the longest time we’ve been in network for everyone,” said Dr. Brett Cannon, a physician and ApolloMD’s president for the Georgia region. Cannon and Swartz said ApolloMD simply wanted to keep the current contract going.
Patients in Georgia and across the nation are increasingly caught in the middle of a battle between insurance companies and care providers over how and how much the providers should be paid. As health care prices soar, health insurance companies are pushing back harder. And when they don’t get their way, they often have the option of walking away and leaving their policyholders stuck with enormous bills.
The Georgia Legislature has grappled with the issue of surprise billing for four years and provided patients with no serious solution. Legislators often propose "transparency" measures meant to increase the likelihood a patient may know he or she is about to be treated by an out-of-network doctor.
Legislative discussions to stop surprise billing have usually broken down over what kind of price list to impose and whether that would be fair to the doctors or to insurance companies.
A Senate bill that would have eliminated surprise billing by requiring insurance companies to pay set rates failed in the House Insurance Committee this year. The committee's chairman, Rep. Richard Smith, R-Columbus, questioned its legality.
Smith said the holdup is that doctors want too much money. “I’ve never had any problem with the insurance companies,” he said. (Doctors say insurance companies won’t negotiate.)
“I’ve talked with physicians, I’ve talked with a lot of different groups on this, and it’s all boils down to more money,” Smith said. “And unfortunately it’s the patient who’s in the middle.”
Smith sponsored a separate bill this year, on transparency. If a patient took the initiative to ask a hospital whether his or her doctors would be in network, the hospital would have been required to tell them. That bill also failed.
Asked whether anything would change next year after four years of failure, Smith said, “I sure hope so.”
WHY IT MATTERS
Starting Sept. 1, all Georgians with Cigna health insurance may be in danger of surprise medical bills when they see a doctor from the organization ApolloMD. ApolloMD represents doctors who are independent contractors. They work in hospitals all over the state as ER doctors, anesthesiologists and hospital doctors.
Cigna and ApolloMD doctors have an insurance contract right now, but Cigna has said it plans to end the contract. That means Cigna will pay what it wants for a visit, and the doctor may bill the patient for the difference. Surprise medical bills can run into the hundreds or thousands of dollars.
A lot of people will be affected. Cigna patients had 23,000 visits with ApolloMD ER doctors in Georgia last year.
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