Dive Transient:
- UnitedHealthcare launched a scathing assertion towards John Hopkins Medication and Capital Ladies’s Care earlier this week, accusing the suppliers of hindering contract negotiations by placing enterprise wants above sufferers’ finest pursuits.
- The assertion is an escalation of a rising battle between the 2 events. Each suppliers went out of community with the insurance coverage big in August, and Johns Hopkins formally referred to as off contract discussions with UnitedHealthcare in late September — a transfer that left roughly 60,000 enrollees unable to entry care on the well being system’s places all through Maryland, Virginia and Washington, D.C.
- UnitedHealthcare says the stalemate in negotiations lies on the toes of the suppliers, claiming Johns Hopkins desires a contract that will permit it to “refuse therapy for any employer it doesn’t wish to do enterprise with,” whereas CWC desires double-digit fee will increase for sure providers.
Dive Perception:
Though for sufferers the end result of each conflicts is identical — confusion about protection and care entry — the disputes on the middle of every is completely different.
The insurer’s dispute with CWC is a well-known story — the ladies’s healthcare supplier desires fee will increase for providers below industrial, Medicaid, and Medicare Benefit plans. Allegations of insufficient reimbursements have been on the middle of contract disputes between payers and suppliers for years, with suppliers saying they want larger funds to maintain up with the elevated value of offering care.
CWC operates 75 girls’s well being middle places all through Maryland, Virginia, and Washington D.C. It says it has skilled elevated hurdles and denials to offering care due to UnitedHealthcare’s insurance policies, in addition to financial challenges.
“Capital Ladies’s Care and its practitioners are experiencing the identical challenges with inflation and the rising prices of provides, providers, worker advantages and associated gadgets that you’re feeling,” CWC stated in an announcement. “Our requested will increase have been humble in comparison with the premium will increase employers and members have borne in recent times and are supposed to assist guarantee we will present the identical degree of care to sufferers.”
UnitedHealthcare disputes this, saying the will increase would make care at CWC services 30% costlier than the common of different OB/GYN suppliers in UnitedHealthcare’s Maryland and Virginia industrial community. The insurer says nearly all of value hikes would fall on sufferers.
In the meantime, Johns Hopkins requested for the suitable to refuse therapy for particular employers, in accordance with UnitedHealthcare.
“Think about exhibiting up on the hospital or clinic and being instructed that you may’t see your physician as a result of Johns Hopkins doesn’t wish to do enterprise along with your employer,” Joseph Ochipinti, UnitedHealthcare’s CEO for the Mid-Atlantic area, wrote within the assertion. “A supplier that selectively and unilaterally turns sufferers away — no matter medical want or protection — disrupts equitable entry to care.”
Johns Hopkins refutes this narrative and says the negotiation breakdowns occurred over the insurers’ practices that created boundaries to care, together with extreme therapy denials and fee delays.
“This was not about cash or small administrative points,” the system stated in an announcement in September. “UnitedHealthcare refused to comply with cheap phrases that will make sure you obtain the care you want, whenever you want it, with out extreme delays or denials. We couldn’t signal a contract that permits an insurance coverage firm to prioritize their earnings over our sufferers’ well being.”
Publicizing contract disputes is turning into an more and more widespread tactic amongst each suppliers and payers, as each try and curry favor with sufferers and stress the opposite occasion to comply with favorable phrases.
This 12 months alone, Jefferson Well being and Cigna, Broward Well being and Florida Blue and Southwestern Well being Assets and a Texas Blues plan have duked out contract negotiations within the public eye.
Dozens of different disputes occur in smaller markets across the nation, in accordance with an evaluation from FTI Consulting, which tracks supplier and payer disputes. The consultancy discovered 55 payer and supplier disputes reported within the media through the first two quarters of 2025, a continuation of a pattern that has been on the rise over the previous a number of years.
UnitedHealthcare is not any stranger to public disputes. In July, roughly 20,000 UnitedHealthcare Rhode Island sufferers misplaced entry to Brown Well being hospitals after the 2 firms failed to barter a brand new contract.
