Cigna MRC2 pricing

Cavalier40

Guest
Messages
138
Location
Stuart, FL Sailfish Chapter
Best answers
0
I was not sure whether to post this here or in the payer section, but since I think this is targeting MH/SA facilities, I will post here.

As an out of network Cigna provider, I would generally negotiate facility based SA claims with Multiplan. I would get the same discounted rate across the board since I have been working with Multiplan for so long. However Cigna is now putting a restriction on the repricing of these claims called MRC2. I am being told they are locking in prices based on Medicare allowed amounts. At first it only effected professional claims which made sense because there was a fee schedule to refer to, However now they are saying facility claims are also being effected by MRC2. This confuses me because there is no Medicare allowed based on revenue code. (Or are there? If so can someone point me to the fee schedule?) They are forcing me into a price that is less than half of what I have been negotiating for 2 years now and if I do not accept their repricing amount, they will only reimburse a fraction of the Medicare allowed (for example I was told that Cigna would pay $407 for 5 days of Residential treatment if I did not accept their repricing, out average expected is over $900 per day)

To be honest I feel bullied and strong armed, however I think they are calling providers bluff in not balance billing the patient. Since the business model for most treatment centers is to not count on patient responsibility and I know that there are many providers who are not in compliance with anti-kickback laws it makes sense for the payers, but it still feels wrong.

I am wondering if anyone has had success with post payment pricing appeals or have other success when getting the patient involved? Any tips on how to counter this would help greatly.
 

sdarrah1

New
Messages
1
Best answers
0
Cigna MRC2 Pricing

Hey there. I know this response is long past your original post regarding the MRC2 but I've also been dealing with Cigna and these proposals for a while. I have not entertained any of the previous proposals prior to MRC2 taking effect and continue with that mind set. When I am contacted for not responding to a proposal, the rep's insist to explain the MRC2 to me, which in my opinion was put in place to intimidate provider's offices. My rebuttal, "We do not have a contract with you all. A proposal on price negotiations will not be accepted. We will balance bill the patient and the patient/insured will have to contact you to negotiate your terms to this plan as I am not required to participate". I know it sounds ugly on my part, however, the rep's are trained to make the provider's feel threatened or feel pushed into accepting the proposal. Just cover yourself as far as the patient and/or patient's family goes. Be sure the patient knows that you're out of network with Cigna, the situation with MRC2 and that they may be balanced billed. (Our office is contracted with some of the Network's within Cigna which we verify insurance prior to patient's appointment.)

Once you sign a proposal, you're most likely signing stating you would be willing to accept the negotiated amount for most Cigna claims.

I do completely agree regarding the kickback laws. This type issue with insurance carrier's, namely Cigna, does seem extremely wrong but there's a hole somewhere that is allowing them to do it without worry.?

Other options: Become contracted with Cigna if the volume of Cigna patient's is high or close the panel to Cigna patient's. I know with MH and SA, there are different standards than General Practice, General Surgery, OMS, ect.

I hope this helps or at least is informational. Enjoy your day!
 

crichmond

New
Messages
9
Best answers
0
I've also been experiencing this and they will not renegotiate pricing post-payment. They pretty much have said if we don't accept the pre-payment pricing terms then we are stuck with the MRC2 pricing and/or the patient has to call to get a higher price. We all know what the chances are that a patient will call to renegotiate though unless they know they will be sent to collections, but even then it's hard to get a patient to call for renegotiation.
 
Top