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Wiki Cigna / ABA therapy

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tanyatnk

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Hello there, I am having difficulty with Cigna and hoping someone out there has some advice.

We are an out of network provider for Cigna. They send our claims to Multiplan, who contacts us to negotiate a payment. Sometimes we are only offered 10-40% of what we bill. Obviously, I do not accept this offer and I send it back to negotiate. Sometimes I am able to get the multiplan reps to pay 80% of our billed amount and sometimes I can only get 40%. Sometimes, they accept my negotiated rate but process the claim at the initial rate of 10%.

Is there anyone else out there having experienced this? What did you do to work around this?
 
Cigna is tricky when it comes to out of network negotiations. They have pricing locks called MRC1 and MRC2 which limits the max allowed a multiplan rep can offer. With those, you either take what you can get or refuse negotiation, get paid an even lower rate (usually 90-110% of CMS) and balance bill the patient. Sometimes after the balance bill is given to the patient, the patient can then call and complain and sometimes you can get better rates that way, but I know its a long shot.

Unfortunately I cannot give you a better answer. I would say maybe try and get a global agreement with Multiplan, but that can backfire as claims that are not subject to the global percentage will automatically go back to the payer without negotiation.

Hope this helps.
 
tanyatnk said:
Hello there, I am having difficulty with Cigna and hoping someone out there has some advice.

We are an out of network provider for Cigna. They send our claims to Multiplan, who contacts us to negotiate a payment. Sometimes we are only offered 10-40% of what we bill. Obviously, I do not accept this offer and I send it back to negotiate. Sometimes I am able to get the multiplan reps to pay 80% of our billed amount and sometimes I can only get 40%. Sometimes, they accept my negotiated rate but process the claim at the initial rate of 10%.

Is there anyone else out there having experienced this? What did you do to work around this?
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We send these claims to our attorney who gets us 80% of fairheath or higher. Cigna doesn’t like to budge too much without attorney involved.
 
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