Break out the popcorn for this one.
According to a recent article in HealthLeaders, UnitedHealthcare has found itself in yet another legal battle. United is no stranger to being sued and at first, this latest lawsuit follows the usual script.
Filed by Nashville, Tennessee-based physician group Envision Healthcare and other physician practices, the suit claims United is offering unfairly low reimbursement rates to force providers out of network.
This is classic insurer strategy – strong-arming physicians to accept drastically reduced payments or leave the insurer’s network. Essentially, these physicians are caught between a rock and a hard place – being paid less than their services are worth, versus seeing fewer patients altogether.
We’ve seen it nationwide – a “take it or leave it” approach to reimbursement negotiations impacts already-struggling health systems, and it also leaves patients on the hook for bills they thought would be covered.
According to the article, United’s legal battle with Envision “has reportedly earned it the nickname ‘evil empire’ among some practitioners, and it is not difficult to see why.”
But this case also includes a surprise twist. The suit claims that not only are United’s negotiation tactics pushing doctors out of network and patients into United-owned Optum healthcare facilities – which it alleges get preferential contracts and reimbursement policies – but that they also serve to drive doctors into Optum’s organization.
From Becker’s Hospital Review:
“It is hardly a coincidence that United has been implementing this scheme against medical groups nationwide while it has simultaneously grown its own healthcare provider group [Optum] into the largest physician practice organization in the United States, accounting for most of United’s annual profits,” the lawsuit states…. Finally, Envision also accused United of driving Envision providers out of network so hospitals would turn to in-network, Optum-owned practices for services and “Optum and/or United could acquire some or all of Envision’s practices at artificially depressed values.”
The force is apparently strong for United, but you might be thinking – why would a doctor join the very ‘evil empire’ organization forcing their hand when it comes to network negotiations? While we can’t say for sure, we can speculate: perhaps after a traumatizing global pandemic, sinking staff-to-patient ratios, rising healthcare costs, and chronically shrinking reimbursement rates, maybe physicians are just…tired? We know we are.
So, if this was an approach a payor was taking… here’s our translation of the strategy:
Step 1: Beat down doctors every year with lower reimbursement rates and be sure to keep the threat of network expulsion hanging over their head.
Step 2: Refuse to negotiate with doctors in good faith. Stud your contracts with loopholes, fine print and escape hatches.
Step 3: Force doctors to take unfair payment cuts and blame them when patients don’t understand why their coverage doesn’t actually cover anything.
Step 4: Wait patiently for the day these doctors get so tired of sitting at the negotiation table instead of practicing medicine that they’ll take the best offer that comes their way.
And who could blame them?