By Mylika Scatliffe
AFRO Health Writer
Thousands of patients of Johns Hopkins Medicine recently received notification that they may lose in-network coverage if the hospital system and the insurance giant, UnitedHealthcare, are unable to reach a new contract by August 24.
As the two organizations clash, approximately 60,000 patients in the mid-Atlantic region face uncertainty. Negotiations have been ongoing for the last several months, and an agreement has been reached for physician payment rates. The major focus of the continued dispute is how medical care is approved and reimbursed.
“For seven months, Johns Hopkins Medicine has negotiated in good faith with UnitedHealthcare, agreeing to their five requests to extend the contract so that we could reach an agreement that puts patients first,” said Kim Hoppe, Johns Hopkins Medicine’s Vice President of Public Relations. “We will not sign a contract that allows an insurance company to put profits over patients’ health and well-being.”
According to a letter from Hopkins to their patients, UHC’s frequent use of pre-authorizations and care denials causes delays in critical treatments and takes away from time that Hopkins doctors and nurses should be spending on patient care. The hospital said this puts patient health at risk. Hopkins’ goal is to come to an agreement with UHC on fair processes and procedures to reduce burdens and delays and provide optimal care for patients.
“Unfortunately, UnitedHealthcare has chosen to slow down recent negotiations because we refused to accept their harmful practices that hurry patients; aggressive claim denials which means delays for necessary care, excessive red tape that forces patients to wait for treatments, and significant payment delays that strain our ability to provide care,” continued Hoppe.
UHC officials are emphatic that money is not their primary concern.
In a letter to their Hopkins patients, UHC confirmed they are actively negotiating with Johns Hopkins Medicine to renew the network relationship between the two organizations. The goal is to reach an agreement that maintains continued network access to the health system.
“Our top priority is to reach an agreement that maintains continued, uninterrupted network access to Johns Hopkins. Our negotiation isn’t about money,” said Joseph Ochipinti, UnitedHealthcare CEO of the Mid-Atlantic region.
UHC has agreed to the rates proposed by Hopkins, because they recognize and appreciate the care provided by Johns Hopkins, but believe the contractual provisions demanded by Hopkins would hurt employers and UHC members.
“We’ve reached agreement on financial terms and offered continued support to help Johns Hopkins more effectively manage the operational aspects of our relationship. However, Johns Hopkins is requiring contractual provisions that would allow them to turn patients away at their discretion, but we will remain at the negotiating table as long as it takes to renew our relationship,” continued Ochipinti.
UHC contends they are working to protect access to care, and that Hopkins should not have the discretion to turn patients away. According to UHC, Hopkins is attempting to reserve the right to turn away UnitedHealthcare members at their discretion as an in-network provider.
UnitedHealthcare finds this unacceptable.
“Our priority is providing people with consistent, reliable, and broad access to care. We expect Johns Hopkins to deliver on its commitment to provide care to the individuals and families who rely on them as an in-network provider,” said UnitedHealthcare, in a statement sent to the AFRO.
United’s current contract with Hopkins is in effect until August 24, 2025. If they are unable to reach an agreement, Johns Hopkins Hospitals will be out-of-network for people enrolled in the following plans, beginning August 25:
- Employer-sponsored commercial plans
- Individual Family Plan (IFP)
- Medicare Advantage plans, including Dual Special Needs Plan (DSNO) and Group Retiree
- Medicaid
- Johns Hopkins physicians would also be out-of-network for employer-sponsored commercial plans, beginning August 25.
Johns Hopkins physicians do not currently participate in United’s Medicare Advantage or Medicaid networks. Only providers in Maryland, Virginia and Washington, D.C. are impacted by the current negotiations. Johns Hopkins provider locations in Florida will remain in-network, regardless of the current negotiation outcome.
A letter to UHC-insured individuals states that if no agreement is reached and Johns Hopkins exits the network, patients may face higher out-of-network costs or pay for services in full.
Patients may select a new hospital from the UHC network, as outlined in a provided list of covered hospitals.
In some situations, people in ongoing treatment with Johns Hopkins providers for serious or complex conditions may be able to continue seeing their providers at the plan’s network costs, for a short time after they leave the network. This is called Continuity of Care.
Examples of conditions that would be eligible for continuity of care include but are not limited to people undergoing chemotherapy or radiation therapy for cancer, or women who are pregnant.
UnitedHealthcare members must apply and be approved for continuity of care.
UHC stated that Johns Hopkin’s experience is consistent with claims approvals data reported publicly on their website, including that 90 percent of claims are approved and paid shortly after they are submitted, with the remaining 10 percent going through an additional review process.
The next step in their process is to verify a patient is a UHC member, check for duplicate claims and confirm that necessary clinical documentation has been submitted by the treating physician. Next is confirmation the service is a covered benefit, followed by an assessment to determine if the service is aligned with the most recent, evidence- based guidelines. The approval rate following this additional review process is 98 percent for claims for eligible members.
UHC contends the majority of the claims mentioned by Hopkins are duplicate submissions, where a provider has submitted the same claim more than once, claims with missing required information, or for a patient that is not a UnitedHealth care member.
Both Johns Hopkins Medicine and UnitedHealthcare state they are committed to providing people with consistent, reliable and broad access to care.
Great Job Mylika Scatliffe AFRO Womens Health Writer & the Team @ AFRO American Newspapers Source link for sharing this story.
