Contract negotiations are nothing new – hospitals and insurance companies renegotiate their rates for services regularly. But the trend of the last few years is upped aggression from payors, where networks are cut mid-contract, or providers are forced to ridiculously low rates to stay in network.
And this isn’t a market-specific problem – this is happening everywhere. Check out our latest roundup below:
WakeMed and UnitedHealthcare
Here we have a contract negotiation that’s lasted longer than an entire year. WakeMed reports that UnitedHealthcare denies reimbursement for medically necessary inpatient care significantly more than any other insurance company, and that while they are committed to finding an equitable partnership with United and all insurers, they don’t see United backing down any time soon.
“Unfortunately,” the hospital says, “UnitedHealthcare has been unwilling to agree to a new, reasonable contract with us.”
CaroMont Health and UnitedHealthcare
Looks like WakeMed isn’t the only North Carolina hospital in UnitedHealthcare’s crosshairs.
CaroMont’s contract with United is set to expire in April, and negotiations between and the potential dispute “is leaving patients…caught in the middle,” noted a local North Carolina news source.
Negotiations are ongoing, but the providers sent a statement to WSOC-TV saying that “Unfortunately, UnitedHealthcare is unyielding in their position that CaroMont Health accept reimbursement rates that are lower than those accepted by other insurers and received by other hospitals and health systems in the region. At this time, it appears UnitedHealthcare will not compromise.”
The University of Mississippi Medical Center and Blue Cross Blue Shield
Last (for now, anyway), we have BlueCross BlueShield and the University of Mississippi Medical Center. In April, BCBS MS dropped the medical center, according to Becker’s Payer Issues, when the two weren’t able to come to terms on a new contract.
In the time since, the state insurance commissioner, Mike Chaney, pushed the two to work with a mediator. After little progress, Chaney sends a letter to BCBS saying “the state will conduct an examination to determine whether the company is following state network adequacy regulations.”
Then, BCBS sues Mississippi Medical Center. Eventually, Chaney suspends the “mediations indefinitely,” saying that if the two parties can’t figure it out, legislators and the governor will handle it.
Meanwhile, Jennifer Lott, a woman suffering from a genetic disorder that causes extended jaw growth, can’t get treatment. Others, including patients with cancer or in need of transplants, have also had their care impacted.
At the end of the day, it seems insurers are coming to the negotiation table willing to do very little negotiating. But hospitals simply can’t function on bare minimum payments – and without them, patients lose access to care.