Come January, health care services rendered in Puerto Rico will no longer be in-network for Cigna policyholders in the territory, so patients who choose to go out-of-territory for treatment will either travel to the mainland or pay more out-of-pocket, according to insurance agents and the V.I. Government.
However, according to Cigna, there are exceptions based on availability of services.
Insurance brokers in the territory recently began raising concerns about the change in corporate policy and how it might affect patients in the U.S. Virgin Islands.
Some ill patients may be forced to spend much more and endure much longer journeys to get treatment as a result, said Steve Baker of Baker, Magras and Associates insurance agency on St. Thomas in a telephone interview Wednesday. The agency handles group health insurance for roughly 350 private businesses throughout the territory, according to Baker.
“If they want to pull out of Puerto Rico, that’s fine with us because we don’t do business in Puerto Rico directly,” said Baker. “But our clientele heavily depends on Puerto Rico providers for services that are not available here. For example, if you need a pulmonologist and one is not available here, if you have to get on a plane and go to Florida, you will have an 1,100-mile journey instead of a 75-mile trip.”
According to Baker, Cigna representatives came to the territory and informed local agencies about the change earlier this month.
“They told us only 1.5 percent of claims from the U.S. Virgin Islands are for care taking place in Puerto Rico,” Baker said.
“We spend ten times that on coordinating travel back and forth to Puerto Rico,” he said. “We think it is more like 10 to 20 percent.”
Government employees receive Cigna insurance through a separate annual contract negotiated by the Group Health Insurance Division with the Personnel Department. Maureen Venzen, the division’s director, confirmed the change Wednesday but suggested the impact would not be dramatic.
“Cigna will no longer be in-network on the island of Puerto Rico, so all services there will be covered out of network,” Venzen said Wednesday. Patients who are in-network pay 20 percent while their insurance pas 80 percent, while those who are out of network pay 40 percent, and the insurance covers 60 percent, she said.
"It does not mean you will necessarily pay more for care in Puerto Rico than Florida [which is in-network] though, because Puerto Rico is one of the least expensive areas for health care,” she said. If it is an emergency, care in Puerto Rico would still be billed at the in-network rate, she said.
But the change will mean that patients who were already getting care in Puerto Rico will pay more for those services come January than they pay right now, Venzen confirmed.
Her office’s statistics show a very small percentage of V.I. government employees’ patient-care dollars being spent in Puerto Rico, similar to the numbers Cigna officials purportedly provided to Baker and other insurance agency representatives.
Of roughly $92 million in claims in 2009, some $1.2 million was spent on care in Puerto Rico, she said. That amounts to 1.3 percent of claims.
A small number of government retirees will not be affected by the change.
“Approximately 91 retirees who reside in Puerto Rico would be covered under an indemnity plan,” she said.
Cigna spokesperson Kathleen Keenan partially confirmed the changes to in-network status on Thursday, but offered more details suggesting the changes are not dramatic.
While Puerto Rico will not automatically be in-network, Keenan confirmed that emergency care will still be at in-network rates. Non-emergency care will generally have to be performed by in-network physicians to receive the in-network rates, so one could not simply choose to go to out-of-network providers in Puerto Rico out of personal preference.
“Non-emergency care, including specialized care, from a hospital or physician in the U.S. is covered at an in-network rate only if you seek care from a hospital or doctor on the Cigna network,” Keenan said in an email. “Customers can confirm whether or not their hospital or doctor is in the network by going to www.cigna.com or calling our 24/7 customer service line on the back of their card.”
But there are exceptions in case of necessity, Keenan said.
“If specialized care is needed and is not available on the Virgin Islands, Cigna customers can get a referral from their physician for specialized care in Puerto Rico with specific physicians and hospitals at an in-network rate,” she said.
