Letter: What happens to us in dispute between Mission and Cigna?

My family received a letter a few Saturdays ago, addressed to “The Kestner Family,” that informed us that Mission Hospital will be out of network with Cigna starting Nov. 1 unless they both can come to a settlement with each other on how much to charge or how much to pay for medical services (depending whose side you’re on).

My husband and I have two children, a boy and a girl. We own a small home and are lucky to have food on our table every day, cars that get us to our jobs, clean clothes and a job that offers health insurance. My husband pays $600 a month for said health insurance, and his employer covers the other half of the cost. In total, $1,200 a month. I’m sure this is a paltry amount to the executives at each of these industries, but for us, $600 buys a lot of groceries and pays a lot of bills.

Even though we pay into insurance each month, we are still expected to pay copays and deductibles. Last summer, when my daughter had to have the most minor of surgeries, it was well over $1,000 to the surgery center, anesthesiologist and the surgeon after what we pay out of pocket every month, and I’ve just now paid off that surgery.

I have no misunderstanding that we are included in an extremely lucky and privileged group to have insurance. I know there are some people who have nothing and avoid health care for major issues that need to be addressed. We’re also “lucky” that our insurance covers at least part of our health care, even if that means we have to make payments to attain said care.

We are being told that because Mission Health and Cigna can’t come to an agreement on how much to pay for the overly inflated cost of care, we will be out of network come Nov. 1, and while I understand that services must be covered, our nurses and doctors must be paid, I also understand that these head-butting issues between hospitals and insurance carriers are ridiculous.

I think back to a few years ago when Mission went toe-to-toe with Blue Cross Blue Shield and all of the issues that it caused our community. (I see now that they decided a big media blitz isn’t the way to go this time, as I only heard about the negotiation issues with Cigna when I received the letter. I guess they want to try and keep this quiet in hopes that folks won’t find out about people going without health care in our region again to keep their public appearance top-notch.)

Cigna kindly told us which hospitals in the area we can now use, and while these hospitals are great for nonemergency needs — such as having a baby (with a normal pregnancy and no need for the neonatal intensive care unit) or for having minor surgeries — if there is a large, life-altering need for health care, Mission is the only hospital in the area that can take care of those needs. It has the only dedicated oncology floor in the area. The only NICU. Pediatric ICU. Heart Tower. Should I go on?

I read stories when Mission went out of network with BCBS of how a parent took their child to what was then Park Ridge Health, for an emergency. The doctors there determined that they couldn’t handle the issue, and the child needed to be sent to Mission’s pediatric ICU. They were left with the bill at Park Ridge, for the ambulance ride to Mission and then the cost of ICU care at the hospital. Not to mention, the hours of stress this family had to endure while their child suffered.

I wonder if this will be the fate of my family should they not work out an agreement between the two entities. When big corporations get into arguments such as these, I wonder if they remember what’s at stake for the people who pay for their lavish lifestyle? Do they understand the undue worry that they cause families? Do they even care?

When I called Cigna, they assured me that “usually” the hospitals and insurance can come to an agreement before the proposed deadline. I beg them to please do and to remember why this business exists. It’s not to make profits; it’s to help the community.

— Katie Kestner
Candler

Editor’s note: Xpress contacted Mission Health and Cigna for a response to a summary of the letter writer’s points. Holly Fussell of Cigna’s Business Communications department offered: “Cigna provides broad access to affordable care. We want Mission Hospital and Mission Children’s Hospital to be a part of the Cigna network. But, if they decide to keep their prices high for customers and employers in Asheville, we will help people find more affordable, convenient, quality care options that are in our network. We have given customers plenty of time to prepare if Mission decides to leave our network. Our customer service team is available 24/7, and our online provider directory is easy to navigate at myCigna.com or on our mobile app. As always, emergencies are covered at the in-network level regardless of where service is received. We want to deliver a simple, affordable, predictable health care experience and hope that Mission will ultimately join us in that commitment.”

We received the following response from Nancy Lindell, public and media relations manager at Mission Health: “The Mission Hospital contract with Cigna continues through Oct. 31. We are actively in discussions with Cigna and hope to reach a positive conclusion on a new agreement prior to that date. Cigna is a long-standing partner, and our goal is to reach an agreement that allows us to continue to provide quality care to those patients who have come to depend upon us. Mission Health is committed to improving the lives and health of the people of Western North Carolina. Please note that any potential impact will not affect other affiliated Mission Health hospitals, physicians or providers. If you have questions, please visit our website at missionhealth.org/cigna for more details.”