Jefferson Health now out-of-network for many with Cigna | What to know and what patients can do – 6ABC Philadelphia

PHILADELPHIA (WPVI) — Consumers gravely concerned about their healthcare are sounding the alarm after Jefferson Health, our region’s largest health system, announced earlier this week that it was unable to finalize a new contract with Cigna Insurance.

Emergency care remains in-network for all Cigna members and patients with Medicare Advantage plans are also unaffected. However, Jefferson Health is now out-of-network for Cigna members who get insurance through their employers.

“I feel frustrated and concerned. My wife’s healthcare providers are all through Jefferson,” David Rosenberg, of Fairmount, told Action News. “She has a number of appointments coming up, including her mammogram.”

Rosenberg says his wife’s family has a history of breast cancer, so she is very vigilant about her checkups.

He received a letter from his children’s pediatrician’s practice that it is now out-of-network” too.

The Rosenbergs don’t don’t feel comfortable switching away from any of their trusted providers.

“They know our family and they know their medical histories,” David said.

Jefferson Health said rising costs made its previous contract with Cigna unsustainable.

“Since 2020, Cigna’s reimbursement rates have increased only around 3%, while the costs of providing care have increased more than 20%,” said Dr. Edmund Pribitkin, Jefferson Health’s Chief Physician.

Cigna claims “Jefferson Health chose to leave our network due to their unreasonable rate hike demands that would raise health costs for the people we serve.”

What can patients do?

“The first thing that you can do is pick up the phone, call the insurance company, and ask them if you qualify for something called a continuing care patient,” said Lisa Gill, with Consumer Reports.

Gill says pregnant women and cancer patients are examples of people who could qualify and receive about a 90-day window to continue their care with their current provider.

She says other patients should ask, “Will they allow you to at least submit claims that are out-of-network? Would any of it be covered? A lot of plans will cover 40%, 50%, sometimes even more than that.”

In the meantime, Jefferson is pleading with patients and providers to contact Cigna directly to express their concerns. Cigna says its customer service advocates are available 24/7 at 1-800-244-6224 and customers can find in-network hospitals and providers on their website or app.

Both Cigna and Jefferson said they are committed to continuing negotiations and it is still possible they reach an agreement.

Some may remember Tower Health hospitals and doctors were out-of-network for Cigna members for four months last year, but those parties did finally agree to a new contract.

Action News will keep you posted on what happens in the case of Cigna and Jefferson Health.

Cigna Healthcare’s full statement to Action News: “Unfortunately Jefferson Health chose to leave our network due to their unreasonable rate hike demands that would raise health costs for the people we serve. Almost all our employer clients’ benefits plans are self-funded, which means any increase in cost of care is paid directly by local employers, their employees and their families. We will continue to negotiate with Jefferson Health to reach a fair agreement that will keep health care affordable for patients. Our customer service advocates are available 24/7/365 to ease the transition and guide patients to high-quality, local in-network care.”

Jefferson Health’s full statement: “Despite our best efforts to reach a fair agreement, Jefferson Health and Cigna have been unable to finalize a new contract. As a result, as of March 15, 2025, Jefferson Health will be considered out-of-network for Cigna commercial members.

“We understand that this news may cause concern, and we want to reassure our patients that we remain committed to providing high-quality care. We continue to negotiate in good faith with Cigna to reach a resolution that is fair and sustainable for our patients, providers, and community.

“For more than 20 years, Jefferson Health has been a trusted provider for Cigna members. However, our current contract does not reflect the true cost of delivering high-quality care. Since 2020, Cigna’s reimbursement rates have increased by only 3%, while the Hospital Wage Index has risen 20% and CPI-U has increased 21%. Rising costs for labor, medical supplies, and operations make it unsustainable to continue at these below-market rates. Other insurers in our communities have recognized these economic realities, and Jefferson has successfully reached agreements with them.

“Emergency care remains in-network for all Cigna members, regardless of contract status.

“Some patients may qualify for Transition of Care programs to maintain in-network benefits. Please check with Cigna.

“Many Cigna plans include out-of-network benefits that may allow continued access to Jefferson providers.

“We encourage Cigna members to contact Cigna directly to understand their coverage options and advocate for continued access to Jefferson Health providers.

“Our priority remains delivering the highest quality care while securing fair agreements that support our mission. We appreciate your patience and support as we work toward a resolution.”