Cigna soon will go out of network with St. Charles Health System; we talk with an affected cancer patient
(Update: Adding video, Jillian Fortner speaks with Cigna members for a report on KTVZ News at Six)
BEND, Ore. (KTVZ) — Beginning October 1, St. Charles Health System will no longer be considered in-network for Cigna Healthcare members, potentially impacting thousands of patients across Central Oregon. The change comes after contract negotiations between the two organizations reached a stalemate.
As of Tuesday, St. Charles website still indicates the contract with Cigna is set to end Sept. 30.
Terrebonne resident Ann Mattson is concerned about how she'll be able to get to and afford treatment for kidney cancer. She was recently diagnosed with renal cell carcinoma.
"I'm kind of in a pickle at this point," said Mattson. "I try my best to keep myself educated and ask questions, but it's overwhelming."
Her doctor suggested traveling to Portland for care, but Mattson said that isn’t realistic.
“Because of my leg that swells, I can’t drive long distances. I don’t drive over the mountain anymore,” Mattson explained. "But my biggest concern, you know, I'm a widow and I live alone."
Bend resident Natalie Schoeppler says her family is also worried about access.
“It's really inconvenient. The nearest hospital that is in-network is over 100 miles away,” Schoeppler said.
Her husband is scheduled for shoulder surgery the day before the contract ends.
“If his surgery was bumped, which happens often, I’m not even sure he’d still be able to have it here at St. Charles," Schoeppler added.
According to Cigna Healthcare, the Bend-based health system notified the insurer of its intent to leave the network earlier this year. Cigna claims the breakdown in talks stems from what it describes as “unreasonable demands” by St. Charles leadership, including a “take it or leave it” ultimatum involving unpredictable reimbursement rates.
“We recognize that St. Charles Health System, like many health care providers across the country, is facing labor shortages and other factors that contribute to cost pressures,” Cigna said on their website. “But we have a responsibility to keep (your) health care costs affordable and predictable.”
Cigna emphasized that most of its business with St. Charles comes through self-funded, employer-sponsored plans — meaning the direct costs of care are paid by employers and employees through payroll deductions. If no agreement is reached by October 1, Cigna members with Open Access Plus (OAP), PPO, or LocalPlus plans will be considered out-of-network when receiving care at St. Charles facilities.
The impacted facilities include:
- St. Charles Medical Center – Bend
- St. Charles Medical Center – Redmond
- St. Charles Medical Center – Prineville
- St. Charles Medical Center – Madras
St. Charles Health System, which serves patients across Central Oregon, says the dispute centers around contract language, specifically about insurance coverage denials for medical treatment.
“Our goal is to find common ground with insurers to address inefficiencies and wasteful processes within our overly complicated payment systems that add cost for everyone – especially our patients,” St. Charles said in a statement. “We negotiated with Cigna for several months but reached an impasse when Cigna would not agree to essential changes related to inefficiencies, administrative burdens, and other significant issues. Effective Oct. 1, St. Charles will be out-of-network for people insured by Cigna.”
The health system said approximately 5,000 patients could be affected by the contract termination. By comparison, St. Charles treated more than 186,000 patients over the past year.
Both organizations expressed regret over the potential impact to patients and say they are committed to helping members navigate care options.
Patients with questions about their coverage are encouraged to contact Cigna member services or visit the St. Charles website for additional resources and updates.
