Here are five notable developments from Cigna over the last month:
1. The Cigna Group has named Eva Borden as chief product officer for its commercial insurance business. Ms. Borden, who joined Cigna in 1999, has held multiple leadership roles. She was appointed president of behavioral health at Evernorth in 2020 and will continue in that role alongside her new position.
2. Starting Oct. 1, Cigna will implement its Evaluation and Management (E/M) Coding Accuracy policy, which reviews CPT codes 99204–99205, 99214–99215, and 99244–99245 for billing accuracy. Under the policy, some services may be adjusted by one level if documentation does not meet guidelines.
The change has drawn pushback from Sen. Richard Blumenthal and the California and Texas medical associations, who are urging Cigna to rescind the policy.
“To better align with the American Medical Association’s Evaluation and Management services guidelines, Cigna Healthcare will implement a new reimbursement and coding accuracy policy for E/M codes that are being inappropriately billed as a higher level,” a Cigna spokesperson told Becker’s. “This review will only apply to approximately 3% of in-network physicians who have a consistent pattern of coding at a higher E/M level compared to their peers. Claims will be individually reviewed for coding accuracy and payment may be adjusted by one level to meet AMA guidelines. Physicians may request reconsideration or appeal our decision if they feel the higher payment is appropriate.”
3. Evernorth, Cigna’s health services division, is investing $3.5 billion in Shields Health Solutions, a specialty pharmacy company spun off after Walgreens went private in August.
The investment, structured as preferred stock, is not expected to significantly affect Cigna’s 2025 adjusted earnings guidance of at least $29.60 per share.
4. On Aug. 28, Manchester, N.H.-based Catholic Medical Center and Cigna reached a new contract, keeping the hospital in-network for all of Cigna’s commercial health insurance products. Without the agreement, the hospital would have gone out of network on Aug. 31.
5. On Sept. 8, Louisville, Ky.-based Norton Healthcare and Norton Children’s went out of network with Cigna Healthcare after the two sides failed to reach a reimbursement agreement.
“Cigna Healthcare has terminated its contract with our organization. This decision to end the contract was made by your insurance carrier, despite our diligent efforts to reach an agreement on fair and adequate reimbursements to provide quality care,” the health system wrote on its website.
