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UnitedHealthcare just cut thousands of emergency room docs from their 2021 network

On January 4, Becker's Hospital Review showed us that we're in for more of the same bad behavior from UnitedHealthcare this year, with a move that could leave many patients without coverage for their COVID-19 treatment right in the midst of the darkest chapter of the pandemic.

We rang in 2021 with yet another big move by UnitedHealthcare: its decision to cut Envision Healthcare from its network after the two companies were unable to come to an agreement regarding physician reimbursement rates. As a result, some 25,000 Envision doctors in 44 states and the District of Columbia—primarily anesthesiologists and emergency physicians—are out-of-network for United members as of January 1, 2021.

Sound familiar? That’s because we’ve heard this story before. In 2018, United threatened to push Envision out-of-network over a rate disagreement, but the two sides ultimately came to a deal — only after Envision agreed to accept 22% rate cuts. Furthermore, United’s recent behavior toward Envision shows continuation of a trend highlighted by Healthcare Dive back in March of 2020: United pressuring private-equity-backed physician staffing groups (like Mednax, US Anesthesia Partners, and TeamHealth) to accept lower rates, and displaying a bullish willingness to cut them from their network entirely if the groups don’t agree to United’s terms.

As we continue to monitor the long-term implications of United wielding its power and influence across the industry (see: Optum’s acquisition of Change Healthcare, in the near-term, we’re most worried about how Envision’s out-of-network status could impact COVID-19 patients. After all, there is no end in sight to this pandemic. And to date, every 1 out of 10 patients hospitalized with COVID-19 has been cared for by an Envision physician. That means that United’s cost-sharing for out-of-network inpatient COVID-19 care could leave many patients with a gap in coverage. Although we’ve ushered in a new year, we already see more of the same from United: the ruthless pursuit of profit.

Original Article:

Nashville, Tenn.-based Envision Healthcare is no longer in UnitedHealthcare's provider network after the organizations couldn't agree on reimbursement rates.

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