Inova Hopes for Deal for Exchange Plan Coverage

Leaders of Inova Loudoun Hospital are working to reach an agreement with at least one Virginia health insurance exchange participant that would allow area residents using that coverage to continue to receive in-network services at its facilities.

However, the likelihood of that happening remains slim.

The prospect of Loudoun residents—and tens of thousands of others in western Fairfax and Prince William counties—not being covered for care at Inova’s medical centers and its affiliated specialists emerged after several of the area’s most active insurance providers pulled out of Virginia’s exchange market.

Aetna, Innovation Health and United Healthcare will not offer individuals coverage through the state’s exchange in 2018. CareFirst Blue Cross/Blue Shield’s coverage, which includes Inova as an in-network provider, is not available to Loudoun residents in the exchange. That leaves Kaiser Permanente and Cigna, which offer exchange coverage in Loudoun, but do not include Inova in their networks.

According to Inova President and COO Mark Stauder, there is some hope that Cigna will add Inova to its list of in-network providers for the exchange plans. Inova and Cigna do have managed care agreements for other Cigna plans, but the hospital network “has not been offered” a contract for the exchange coverage.

“We have had conversations throughout the year,” Stauder said. “We’ve had many, many conversations.”

While those talks have failed to generate a deal, more meetings are planned, he said. And Stauder said input from Cigna’s customers or prospective customers could help advance the negotiations.

How many people will be affected? During 2017, Inova served nearly 75,000 patients in the area west of Rt. 123 in Fairfax who subscribed to exchange coverages. The out-of-network concern only involved policies issued through the state exchange, not conventional policies such as those offered through an employer.

What happens to exchange coverage patients if no in-network deal is worked out? Many patients could be forced to find new in-network doctors. That’s a big deal, Stauder said. “They do not want to give up their relationships.”

But care won’t be refused in emergency cases. Patients coming to Inova’s emergency rooms would still be treated and stabilized, if needed. After that, it would be the providers’ call whether the patients would be admitted for additional treatment or transported to another hospital with an in-network contract.

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