Ascension Wisconsin is no longer in-network for patients with health insurance through UnitedHealthcare, after the two sides could not agree on a new contract, with new payment rates.
The two sides had been locked in a standoff over new payment rates for months, with each side blaming the other for stagnation in the negotiations, which were ongoing up to the Oct. 1 deadline.
“Despite our best efforts, we were unable to come to terms that reflect the rising cost of delivering care in today’s environment,” said a statement from Ascension Wisconsin, provided by spokesperson Mo Moorman.
“We recognize this change may be disruptive and concerning for our patients. We are committed to helping those affected understand their options and continue accessing the care they need,” the statement continued.
The situation will mean hard choices for patients, including whether to switch doctors or change health plans.
UnitedHealthcare is the nation’s largest health insurer and a major player in Wisconsin. Ascension is a national health system based in Missouri, with a heavy presence in southeast Wisconsin and the Fox Valley.
The change affects patients with insurance through UnitedHealthcare receiving care at Ascension Wisconsin’s hospitals, outpatient facilities and physician practices, as well as associated practices of Ascension Medical Group, according to Ascension’s statement.
Some patients undergoing treatment may be able to continue seeing their doctor at in-network rates for a limited time. Those patients should contact UnitedHealthcare to ask about “continuity of care.”
According to the federal Centers for Medicare and Medicaid Services, patients who may qualify are those who:
Are undergoing treatment for a serious and complex illnessAre undergoing institutional or inpatient careAre scheduled to get non-elective surgeryAre pregnant and undergoing treatmentAre terminally ill
Ascension Wisconsin is urging patients with health insurance through UnitedHealthcare to move to other health plans that have Ascension Wisconsin in their network during the open enrollment period this fall.
Meanwhile, in patient letters ahead of the Oct. 1 deadline, UnitedHealthcare advised some of its members to find new, in-network doctors so they could continue to get care at cheaper costs.
The contract dispute was over payment rates. Health insurance companies and hospital systems regularly negotiate reimbursement rates for health care services.
UnitedHealthcare accused Ascension Wisconsin of demanding “unsustainable price hikes,” while Ascension said it was seeking a fair and competitive contract that would adequately reimburse its hospitals and clinics.
“The reimbursement rates UnitedHealthcare proposed do not adequately account for the significant financial pressures facing healthcare providers, including unprecedented inflation, and rising costs for equipment and medications,” Ascension Wisconsin’s statement on Oct. 1 said.
Meanwhile, UnitedHealthcare said it was proposing “market-competitive rates” that would “reimburse Ascension fairly and similarly to its peers while slowing the unsustainable rise in health care costs” and contain already rising premiums and out-of-pocket costs.
This is a developing story and will be updated.