Another contract dispute with a Pennsylvania health network is threatening to disrupt in-network care for UnitedHealthcare (UHC) members.
Less than two months after Lehigh Valley Health Network (LVHN) became out of network for UHC commercial plans, Main Line Health is warning its patients that a similar outcome is possible.
Main Line Health operates five hospitals, as well as a number of outpatient and specialty health centers, in the Philadelphia region and its suburbs.
Main Line has notified its patients that its current contract with UnitedHealthcare expires on June 30. If the two sides can’t reach an agreement, UHC employer-sponsored commercial plans and Medicare Advantage plans will be out of network starting July 1.
Both Main Line Health and UHC are blaming each other for the dispute, and both are airing their grievances on their respective websites.
UHC claims Main Line is demanding price hikes for its commercial plans that would significantly increase health care costs for payers, while also seeking rate increases for Medicare Advantage plans that would make them the most expensive in all of Pennsylvania.
Main Line Health, though, claims UnitedHealthcare continues to put up roadblocks, including issuing reimbursements that have not kept pace with the cost of delivering care, as well as delays, denials and prior authorization requirements that can “slow or interrupt care.”
“For nearly a year, we have been working to reach an agreement that protects patient access and addresses ongoing challenges that can delay or disrupt care. To date, UHC has not taken meaningful steps to resolve these issues,” Main Line Health wrote on its website.
According to UnitedHealthcare, it negotiates thousands of contracts each year, with the vast majority of them resolved with no disruption to patient care. “Unfortunately, a small number of health systems choose to negotiate publicly, putting their patients in the middle of these discussions as potential leverage to obtain the price increases they are seeking,” UHC wrote on its website.
The statement is perhaps also a swipe at LVHN, which became out of network for UHC commercial plans on April 26. The Medicare Advantage contract between the two ended on January 26.
LVHN, which is part of Jefferson Health, maintained that, since 2021, UnitedHealthcare reduced its reimbursements by nearly 40 percent without agreement, prompting the health network to take legal action in 2023 to compel UHC to honor the established rates.
But UHC said LVHN was demanding a more than 20% price hike in one year, “which would make it significantly more expensive than the average cost of all other hospitals in our network throughout eastern Pennsylvania.”
Jefferson Health CEO Dr. Joseph Cacchione, during an appearance a month ago on the television show Business Matters, which airs on WFMZ-TV, said LVHN was ready to negotiate with UHC, but the health insurance company had gone “radio silent.”
Earlier this week U.S. Rep. Rob Bresnahan (R-Pa. 8) issued a letter to the heads of both UnitedHealthcare and Jefferson Health, urging the two sides to work out an agreement.
“Since this breakdown occurred, my office has heard from constituents across Northeastern Pennsylvania who are frustrated, concerned, and increasingly uncertain about their access to healthcare,” Bresnahan wrote, in a news release. “Families who have spent years building relationships with their doctors are now being forced to navigate confusing coverage changes, higher costs, and disruptions to care through no fault of their own.”
Bresnahan called the impasse “unacceptable.”
“Both of your organizations serve tens of thousands of Pennsylvanians and have a responsibility to ensure patients are not used as leverage in negotiations,” he wrote. “Healthcare decisions should be driven by what is best for patients, not by prolonged disputes that create uncertainty and financial hardship for the very people your organizations are meant to serve.”