As healthcare costs escalate nationwide, one local hospital is frustrated that a major insurer won’t fairly compensate them for the services they provide.
Augusta Health and Cigna insurance are at an impasse – unable to reach an agreement on a rate for services in 2026 and beyond.
If the two parties fail to come to terms before Dec. 31, Augusta Health will no longer offer in-network rates for Cigna members for any care, except behavioral health, which is negotiated separately, in the new year.
The Augusta Health Board of Directors believes the reimbursement rates proposed by the insurance company fall short of addressing rising costs. Augusta Health reports a 52 percent increase in costs over the last five years. It is also among the lowest paid by Cigna in the local market, according to a statement from the hospital.
“We seek fair reimbursement rates consistent with regional providers — nothing more, nothing less,” said Mary N. Mannix, president and CEO of Augusta Health.
Augusta Health is announcing the potential change in rates for Cigna members now, so impacted individuals have time to review their options for continuity of care or transition coverage.
The hospital is also encouraging Cigna members to contact the insurance company’s member services department to ask them to continue meaningful discussions with Augusta Health.
Why it matters more than ever
Ongoing funding pressures make fair compensation from insurers more important than ever.
The Big Ugly Bill passed this summer by the MAGA-led Congress already forced Augusta Medical Group to close and consolidate operations in the region in rural settings.
“Financial sustainability of rural and semi-rural hospitals is threatened by the trend of lower reimbursement, which is not keeping pace with inflation,” Mannix said.
With the legislation, Republicans passed the largest Medicaid cuts in history which will drastically increase uncompensated care for hospitals.
The federal government shut down on Wednesday, as Democratic lawmakers pushed to negotiate the cuts Republicans made to Medicaid in its government spending bill.
ICYMI
- Congress | Warner, Kaine on Augusta Health OBBB closures: ‘Partisan tax bill’ to blame
- Big Ugly Bill fallout | Augusta Medical Group closing three primary care facilities
- The Medicaid cuts aren’t an other people problem: They impact us all
Twenty-eight percent of Augusta Health’s patients have their healthcare costs covered by Medicaid. In 2023, Augusta Health reported a $6.7 million shortfall in reimbursements from Medicaid. It also provided $9.1 million in financial assistance to patients, according to its IRS filing.
If local residents are dropped from Medicaid or hospitals receive less federal reimbursement, healthcare providers like Augusta Health will have to take on even more losses.
Many experts believe some rural healthcare providers will shutter as they are pushed to the brink..
Democratic legislators are also fighting for tax credits in place since COVID to be extended. Under the Big Ugly Bill, the subsidies will expire at the end of the year. Estimates are that low- to middle-income households whose insurance is purchased through the Affordable Care Act will see their premiums double if Congress doesn’t do something to change the course.
Republicans wanted to pass a funding bill now and address the healthcare concerns later.
U.S. Sens. Mark Warner and Tim Kaine (both D-VA) joined other Democratic legislators in demanding that the issue is addressed now to allay the fears of Americans.
“As soon as tomorrow, millions of families will begin receiving notices that their health care premiums and deductibles are set to skyrocket next year – direct consequences of Republican choices,” the senators said in a statement.
Related stories
- Spanberger pledges to address coming shortfalls that could cripple rural healthcare
- Augusta Health on the brink? Hospital makes plea to save Medicaid
- Augusta Health, Valley Community Services Board brace for impact of Medicaid cuts
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Crystal Graham
