When UNC Health and Cigna failed to reach a contract agreement, 60,000+ North Carolina patients were left scrambling. But the deeper lesson isn’t just about one health system — it’s about how downcoding, administrative overload, and payer tactics are threatening revenue and continuity of care nationwide. This post breaks down the real risks, early warning signs, and how providers can proactively protect their revenue and patients before their own contracts are at risk.
When Cigna Healthcare's R49 policy made headlines in October 2025, many assumed it was an isolated case. Cigna Healthcare then paused the policy due to regulatory pressure. The relief was short-lived. The trend didn't stop; it had already spread to nearly every major insurer in the country.
Aetna’s CCRP quietly began downcoding high-level E/M claims in March 2025, joining Cigna’s R49 policy effective Oct 1. Providers face hidden revenue loss, delayed payments, and rising admin burden. Learn how Downcoding Defense™ tools protect your practice.
Sep 296 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
⚠️ Is Your Practice at Risk?
Book a complimentary 15-minute contract risk call this week.
I'll help you identify:
✓ Hidden revenue leaks in your payer contracts
✓ Downcoding exposure you might not see
✓ Early warning signs of contract breakdown
