December 23, 2019
Area(s) of Interest: Payor Contracting Practice Management
The California Medical Association (CMA) has learned that Dignity Health System and Cigna notified physicians of a potential systemwide termination of their agreement if the two parties cannot come to terms on a new contract by December 31, 2019. If they are unable to come to an agreement before the end of the year, terminations will occur as follows:
- Dignity Health California hospitals, ambulatory surgery centers, and ancillary provider agreements will terminate on December 31, 2019.
- PPO agreements for Dignity Health Medical Foundation Physicians and Hospital-based Clinics will terminate on January 31, 2020.
- HMO agreements for Dignity Health Medical Foundation physicians will terminate on March 31, 2020.
The notices advise physicians that as a condition of their Cigna contracts, they must obtain unrestricted admitting privileges at another in-network hospital or make arrangements to admit Cigna patients to another hospital in its network by January 1, 2020. Failure to do so will result in termination of their Cigna contracts.
Physicians who can attest to having admitting privileges at another Cigna hospital or who have arrangements with a participating provider to admit Cigna patients at another contracted hospital should complete the attestation and return it to Cigna immediately.
It remains to be seen whether the two parties will come to terms before the contract termination becomes effective. CMA will provide additional information on this issue as it becomes available.
Patients may be able to continue to see their out-of-network physicians under California’s continuity of care law. Under continuity of care laws, patients with an acute condition, serious chronic condition, duration of a pregnancy, duration of a terminal illness, care of children between birth and 36 months, or for the performance of a surgery or other procedure that has been authorized, may qualify to request continuity of care.
For information on requesting continuity of care, Cigna has prepared a resource on Transition of Care/Continuity of Care. For questions on continuity of care or for more information, physicians should call Cigna Customer Service at (800) 882-4462.
For more information on continuity of care requirements, see CMA health law library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.”
Contact: CMA’s Reimbursement Helpline at (888) 401-5911 or email@example.com.