Healthcare providers say the fight between Johns Hopkins Medicine and UnitedHealthCare is about aggressive tactics used by insurance companies that are compromising patient care.
JHM providers are no longer in-network for UHC plans after a deadline passed on Monday for the two to reach a contract agreement.
The rift wasn’t about money, but rather about UHC’s policies. JHM stated that UHC was aggressively denying claims and using red tape to slow claims approvals.
“Is this really how we want to manage healthcare?” said Gene Ransom, the CEO of the Maryland State Medical Society. “Where insurance company bureaucrats, who are more focused on the quarterly profits of their stockholders than they are in the people they insure, are trying to put procedures in place where care doesn't happen so they make more money, because that's what this is all about.”
Ransom said JHM is in a unique position to push back on UHC because of its size and status as a nonprofit.
JHM is able to put pressure on UHC and take the hit of losing patients.
“Lately, it seems, anecdotally, from talking to my physician members, that United has been more aggressive as of late with regards to denials,” Ransom said, however he noted that he gets complaints about all carriers. “These types of policies and procedures that are set up to deny or not pay for care are pretty commonplace in the insurance market, and there needs to be some kind of balance, some kind of protection, and it's difficult a lot of times. Smaller physicians can't do things like drop plans or fight, and these bigger groups can, so hopefully they can call attention to it.”
However, patients may suffer.
Currently, according to Ransom, there are no OB-GYNs in Carroll County that fall under a United plan.
That means people may need to travel or go without a doctor if they need care.
Care could continue if the two come to a late agreement.
“Johns Hopkins agreed to five previous requests from United for extensions. If we granted a sixth extension, we know that they would not use that time to agree to contractual language that would prioritize patient care,” Hoppe said. “Providing the care that our patients need and deserve is and always will be our number one priority, which is why we are standing firm that United has to revise the contract language.”
Johns Hopkins and UnitedHealthCare have been in negotiations for the last eight months.
“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.” said Joseph Ochipinti, UnitedHealthcare CEO, Mid-Atlantic region. “Despite our repeated efforts to compromise and extend our contract to avoid disruption, Johns Hopkins refused. 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.”
There are a few loopholes for patients. People in active or ongoing treatment for serious or complex conditions may apply for a continuation of care to finish their treatment.
