Battle Between Health Care Giants Puts Patient Access in Jeopardy

Hundreds of Tenet facilities may leave Cigna’s networks over pay dispute.

We reported last week about a business practice Cigna has once again put in place to automatically downcode several procedures used by physicians for reimbursement purposes – a practice the company agreed to stop using as a condition of settling a massive class action lawsuit 21 years ago. This resurrected downcoding scheme will result in big cuts in pay for many of the country’s doctors but help the insurance conglomerate meet Wall Street’s profit expectations, something it hasn’t been doing this year.

But downcoding is not the only way the company might be shortchanging health care providers – or attempting to do – to get back into investors’ good graces.

According to sources, Cigna is now trying to slash reimbursement for outpatient care at hundreds of ambulatory surgical centers (ASCs) operated by Tenet Health – and possibly other health care providers.

A little background and context: When Cigna announced second quarter earnings on July 31, investors overall were not pleased and sold millions of the company’s shares (despite the fact that Cigna made $3.8 billion in operating profits during the first six months of 2025), sending the stock price down more than 10% that day. One reason for shareholders’ unhappiness was the admission by Cigna executives that the company had spent more money paying claims than it had in the same period a year ago.

A HEALTH CARE un-covered reader shared a recent letter with me that Tenet sent to health care agents and brokers informing them that negotiations for a new agreement with Cigna have stalled and that Tenet’s 64 hospitals and nearly 370 ASCs will be no longer be in Cigna’s provider networks unless an agreement is reached soon.

Tenet operates the largest network of ASCs in the country, and for the past several years, hundreds of thousands of people enrolled in Cigna’s health plans have had in-network access to them. With open enrollment for most commercial health insurance plans starting in less than two weeks – for coverage effective January 1, 2026 – only days remain for Cigna’s health plan enrollees to know whether they’ll continue to have access to Tenet’s facilities. If an agreement isn’t reached, many Cigna health plan enrollees will have fewer options and likely will have to travel farther from home for care at an outpatient facility or hospital that is still in the company’s provider network.

In its letter to brokers, Tenet said:

“While we are negotiating in good faith to preserve in-network access for Cigna members, Cigna has proposed contract terms that could put patient care and access at risk. Their recent proposal includes annual rate increases well below inflation and even cuts reimbursement for access to physicians and ambulatory care. Meanwhile, Cigna publicly reported premium revenue per member increases of 10% for their employer-insured products.”

Tenet urged brokers to alert their employer clients to the “potential disruption ahead of open enrollment” and to help their clients “evaluate alternative [health] plans” that will continue to include Tenet in their networks. The letter noted that Tenet’s hospitals and outpatient facilities “remain in-network with all [other] major health plans.” (Curiously, the two sides apparently are not at odds on reimbursement to Tenet hospitals, just the ASCs.)

If Tenet’s hospitals or ASCs are not in Cigna’s network after January 1, many Cigna enrollees could face a disruption in their care or higher out-of-pocket costs if they continue to see the doctors who work at Tenet’s facilities.

In addition to the letter to brokers, the company also sent a similar letter to Cigna’s employer customers.

Cigna’s demands seem to run counter to an industry-wide strategy – and even Cigna’s own strategy – of shifting more care delivery to outpatient settings where it is often up to 50% cheaper than the same care delivered in a hospital. Tenet’s decision to open or acquire hundreds of ASCs in recent years was in response to that insurance industry strategy and, according to data I’ve seen, prices at Tenet’s ASCs are often less than at similar facilities. So you would think Cigna would be looking to increase access to ASCs, not reduce it. If Tenet’s outpatient facilities go out of network next year, more of its health plan enrollees undoubtedly will get care in a hospital, which will cost Cigna’s employer customers and patients more.

Disputes between insurers and health care providers have become far more prevalent this year than in the past as big for-profit insurers like Cigna have come under intense pressure from investors to improve their profit margins. Modern Healthcare reported that as of Sept. 1, according to an analysis by FTI Consulting, there were 79 confirmed contract disputes between insurers and providers this year. Most of the disputes involved reimbursement issues for insurers’ commercial or Medicare Advantage plans – or both – but increasingly, hospitals and physician groups are balking at insurers’ increasingly aggressive use of prior authorization. Several hospitals and physician groups have announced that they are dropping out of insurers’ Medicare Advantage networks.

Open enrollment for Medicare beneficiaries is already underway, and many seniors enrolled in Medicare Advantage plans are finding out that providers they’ve been seeing will not be in-network as of January 1. It seems likely that people enrolled in insurers’ ACA marketplace plans and employer-sponsored plans might soon find that they, too, will have fewer provider options next year because of actions being taken by insurers to reward their shareholders more generously.