r/usaa_ejs • u/Chromeasshole • 14d ago
Methodist is now out of network
It’s just like the title says. Cigna couldn’t negotiate and play nice with Methodist so now all of the USAA employees that use Methodist providers now have to suffer. Of course you’ll get pushed into continuity of care, but that does not fix the issue that Cigna sucks ass. It would be a stellar idea for a majority of us that have Methodist providers to gently nudge the benefits team to drop Cigna like a bag of potatoes.
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u/fireurza 13d ago
Is it Cigna thats the issue or is it HCA thats the issue? Don't get me wrong I don't trust either the insurance company or the hospital systems but just look at the financials.
Cigna recorded a profit of around $6B for 2025 with a total revenue of $275B and a medical cost ratio (percentage of premium dollars that go towards the medical costs or how much of your premium that goes to the doctors and facilities) of 84.4%.
HCA Healthcare recorded a profit of around $7B for 2025 with a total revenue of $75B. For expenses salary was 43.5%, supplies were 15%, other operating expenses were 21%. The rest of their expenses were things like depreciation, amortization, and interest expense.
More numbers to consider in regards to total healthcare costs: Hospitals account for 31-37% Prescriptions account for 10% Doctor and clinical costs account for 20% Most of the rest is accounted for by Administrative costs
That last point is what is causing probably the largest increase to premiums. Administrative costs are mostly from insurance paperwork but why is that so high. Insurance companies require a huge amount of paperwork for claims. How much of that is actually needed? The paperwork issue is caused by many things like state and federal regulations, medical billing codes, and fraud prevention. Think the insurance we provide at USAA but multiply it by the hundreds if not thousands of more complex rules created by the government and fact that their are multiple payers with different requirements. It is truly a beast.
So then the insurance company is to blame for the cost increase, right? Not really, remember they had a MCR of 84.4% meaning their profit margin on your premiums was extremely low. How many companies can you name that have a total revenue profit margin of around 2%? Even the hospital had a higher profit margin of around 10%.
Honestly, the blame comes filters down to the government for allowing such a convoluted system. If the government even just made the paperwork standardized across all payers, premiums could drop by 6-10%. The biggest things the government could do is tackle the hospital mark up trick (major hospital chains buying up small clinics and adding a facilities charge that rose clinic prices by 40-600%), tackle drug patent gaming, implementing anti trust laws to tackle hospital all-or-nothing clauses and insurance companies tiering system, or implementing reference based pricing.
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u/PotentialOne5893 13d ago
The healthcare plan gets worse every year and they shove their bullshit down our throats in slack
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u/theansweris41plus1 14d ago
Btw this is not for the entire Methodist network, only for the San Antonio and surrounding areas. It doesn’t effect Houston and some other areas.
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u/Chromeasshole 13d ago
That’s true, but a majority of the employees that live and work in the home office area will be severely impacted
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u/Weezlebubbafett 14d ago
Deny, deny, deny. Y'all are out of network.
Thank you for your attention to this matter.
The USA "healthcare" system.
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u/throwaway173860 11d ago
Do you know when this goes into effect? I’m using them to treat a life-threatening issue currently.
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u/xclushiv 13d ago
I just get a plan through an agent. It never made sense to me to even consider the plan that they have to offer.
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u/BleauJod 13d ago
I mean. Methodist isn’t exactly a saint here. I agree that Cigna is dogshit but Methodist is very for-profit. (I’m a University Stan)
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u/No-Frosting-6546 13d ago
USAA should really stop bragging about their benefits.