Johns Hopkins Medicine and UnitedHealthcare officially ended their negotiations to continue doing business with each other on Monday.
The two had a deadline to sign a new contract at the end of August, but were unable to come to an agreement. The organizations continued their negotiations past the deadline, but are now officially calling it quits.
About 60,000 people in Maryland, D.C. and Virginia who use UHC lost in-network status for Hopkins providers once that deadline passed.
“UnitedHealthcare refused to agree to reasonable contract language, instead insisting that we agree to terms that would make it difficult for us to provide patient care,” said Kim Hoppe, vice president of public relations. “UnitedHealthcare had the opportunity to listen to our concerns in a meaningful way and prioritize what matters most: ensuring patients get the care they need, when they need it, without excessive delays or denials. Unfortunately, they chose profits over patients. We decided to make patients aware of this stalemate now, to provide our patients and their employers the time they need to explore alternative insurance options during the upcoming open enrollment season.”
UHC is pointing the finger at JHM.
“Johns Hopkins informed us today it is walking away from our negotiation because we will not agree to language that allows it to refuse treatment for any member with an employer-based plan it does not want to do business with. Johns Hopkins’ demands are unacceptable,” said Joseph Ochipinti, UnitedHealthcare CEO, Mid-Atlantic region.
JHM wanted concessions for UHC that show the company will stop high volume denials and bureaucratic foot dragging that causes patients to wait for treatments.
According to a recent study, UHC is the worst company for claims denials on public plans, rejecting about a third of all claims.
Many providers in the area said UHC’s practices are hurting patients.
“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.
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.
