Thousands of patients insured by UnitedHealthcare cut off from in-network care at Johns Hopkins Medicine

By Megan Sayles
AFRO Staff Writer
msayles@afro.com

Following eight months of failed negotiations, UnitedHealthcare (UHC) will no longer offer services through Johns Hopkins Medicine (JHM) as in-network care. The move impacts thousands of patients in the Maryland area who will now have to pay out-of-pocket if they wish to continue seeing JHM providers. The ongoing dispute between JHM and the insurance company was centered on how medical care is approved and reimbursed.

In a letter to patients on Aug. 25, Theodore L. DeWeese, CEO of Johns Hopkins Medicine, and Kevin W. Sowers, president of Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine, characterized the split as a matter of patient protection. 

“This is not about money or small administrative issues. We have been negotiating with United to protect you from practices that put insurance company profits ahead of patient health and well-being,” wrote DeWeese and Sowers in the letter to patients. “United’s frequent use of pre-authorizations and care denials delays critical treatments, takes away time that Johns Hopkins doctors and nurses should be spending on patient care and puts patients’ health at risk. We will not sign a contract that allows an insurance company to prioritize their profits over our patients’ health.” 

Now that facilities and providers with Johns Hopkins Medicine are considered out-of-network, UHC will cover less—or none— of the costs associated with care that patients receive. This applies to employer-sponsored plans, individual and family plans, Medicare Advantage plans and Medicaid plans. Johns Hopkins’ exit front the network affects nearly 60,000 people in D.C., Maryland and Virginia. 

Individuals who are undergoing active or ongoing treatments for a serious or complex condition as of Aug. 25, like pregnant women and people fighting cancer, may be eligible for continuity-of-care coverage, which allows them to continue receiving care from their current provider at in-network rates until their treatment concludes. UHC members who’ve already scheduled transplants or are currently undergoing transplant treatment as of Aug. 25 will also continue receiving care at in-network rates. 

Since negotiations started, UHC says it’s repeatedly compromised with Johns Hopkins. However, the insurance company asserted that it could not concede on contract terms that would have allowed JHM to refuse certain patients at its discretion and required UHC to pay for claims submitted in error, like when a patient switches insurance. 

UHC also says Johns Hopkins’ allegations about how the insurance company handles its claims have been misleading and inaccurate. UHC reportedly approves and pays 90 percent of claims shortly after they’ve been submitted, while the other 10 percent undergo an additional review process.

Claims can be flagged for further examination for reasons, including eligibility concerns, duplicate submissions, documentation issues, coverage questions or clinical review. Once the additional review process is complete, UHC’s approval rate sits at 98 percent.

“Johns Hopkins refused to move off contractual terms no other health system in our network requires, including language that would allow it to deny patient access at its discretion. Despite our repeated efforts to compromise and extend our contract to avoid disruption, Johns Hopkins refused,” said Joseph Ochipinti, CEO of UHC in the Mid-Atlantic region, in a statement sent to the AFRO. “While we remain committed to continued negotiation, our top priority now is providing people with the care they need through continuity of care or a smooth transition to another provider as appropriate.” 

Both institutions have vowed to continue negotiations amid the split, while patients navigate continuity-of-care options or find alternate providers. UHC members can visit https://www.uhc.com/hopkins/faqs for more information.