Updated Wednesday, Sept. 17 at 6 p.m. ET. This story initially published on August 26.
Johns Hopkins Medicine and UnitedHealthcare (UHC) officially ended contract talks after failing to reach common ground on a new contract agreement.
More than eight months of negotiations came to a head at the end of August when the prior agreement between the academic health system and the nation’s largest private health insurer came to an end. The organizations continued their negotiations past the deadline, but were unable to strike a new deal and the academic medical center will not return to the insurer's network.
"Despite our best efforts to find common ground over the past eight months of negotiations, Johns Hopkins Medicine and UnitedHealthcare have concluded contract negotiations without reaching an agreement," Johns Hopkins Medicine said in a statement posted to its website on Tuesday.
Hopkins providers have been out of UnitedHealthcare’s network for an estimated 60,000 patients, mostly in Maryland, but also in Washington, D.C., and Virginia, since Aug. 25, the Baltimore Banner reported.
Those 60,000 patients will have to find new providers or pay higher out-of-pocket costs to continue to see their doctors and get care at Johns Hopkins hospitals.
Johns Hopkins Medicine spans more than 50 total care locations, including six hospitals, and serves patients in Maryland, Virginia, Washington, D.C. and Florida.
Both parties are warning patients that Johns Hopkins’ hospitals and other facilities are now out of network for enrollees in UHC’s employer-sponsored commercial plans, Individual Family Plan, Medicaid and Medicare Advantage plans, including Dual Special Needs Plan and Group Retiree. Johns Hopkins physicians, who only participated in UHC’s employer-sponsored commercial plans, are also now out of network.
Johns Hopkins All Children’s Hospital, in Florida, remains in network.
Any UnitedHealthcare member that was already approved for transplant services at Johns Hopkins at the time they went out of network will continue to have in-network access for those services at Johns Hopkins, UHC said.
Patients in active or ongoing treatment for a serious or complex condition with a Johns Hopkins provider at the time it left the UHC network are eligible to continue care for a period of time at in-network costs. Continuity of care allows patients to continue accessing care with their provider at in-network rates for a minimum of 90 days, though it could be longer depending on the course of their treatment, the insurer said.
Conditions that would be eligible for continuity of care include people in active treatment for cancer and women who are pregnant.
Throughout months of negotiations, Johns Hopkins and UnitedHealthcare extended contract talks five times past the deadline, the academic medical center said.
The breakdown wasn’t related to contracting rates, where both sides reached an agreement on higher payments. The issue arose from the terms each side sought surrounding the ability to refuse payments or services. Hopkins and UnitedHealthcare said the disagreements centered on provisions each said would be detrimental to patients.
"Despite our best efforts, UnitedHealthcare refused to agree to reasonable contract language that prioritizes patient protections and access, instead insisting that we agree to terms that would make it difficult for us to provide care," Johns Hopkins said in the statement on its website.
It is still possible that the health system could come to an agreement with UHC in the future and return to in-network status, Johns Hopkins said. But Hopkins said the health insurance giant was "unwilling to remove problematic language from their contract, language that allows them to continue to delay and deny care coverage."
Johns Hopkins, in an online FAQ and in an emailed statement to Fierce Healthcare, pointed to UHC’s practices around “excessive” prior authorization requirements, “frequent” treatment denials and millions of dollars in delayed payments. The system said the terms it’s seeking are intended to curb those practices, which it said strain staff and impede care delivery.
“This is not about money, nor is it about small administrative issues,” Kim Hoppe, vice president of public relations at Johns Hopkins Medicine, said in an emailed statement back in late August. Johns Hopkins Medicine was negotiating its contract with United so that it could "avoid aggressive claim denials that delay necessary care, excessive red tape that forces patients to wait for treatments, and significant payment delays that strain our ability to provide care."
"We will not sign a contract that allows an insurance company to put profits over patients' health and well-being," Hoppe said.
UHC said that it’s refusing the system's preferred contractual provisions to protect its enrollees' access to care.
“Johns Hopkins informed us 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," Joseph Ochipinti, UnitedHealthcare CEO, Mid-Atlantic region, said in a statement.
"Johns Hopkins’ demands are not acceptable. We will not allow any health system to turn patients away at their discretion. We expect network providers to honor their commitment to care for the individuals and families who rely on them as in-network providers. A provider who selectively turns patients away—regardless of medical need or coverage— undermines the foundation of what it means to be a network provider. We remain at the negotiating table and ask Johns Hopkins to do what’s right for the people we serve by providing access to care for all patients," Ochipinti said.
UHC is preparing to send a counter proposal on contract language later in the week. The insurance giant said the two organizations reached agreement on financial terms, but UHC asserts that Johns Hopkins is demanding contractual provisions that would harm its members and customers.
Another sore point is a demand that UHC plans be responsible for certain claims submitted by the health system for nonmembers, the insurer said, while giving the example of an enrollee whose recent switch to a new insurance carrier was not vetted by Johns Hopkins when they returned for additional services.
UHC, which has faced a spate of bad news and negative press reports in the past year, also pushed back on Johns Hopkins’ "misleading and inaccurate allegations" regarding how it processes claims. The insurer said the system’s rates of denial are “consistent” with its publicly reported numbers, where 10% of claims are put through additional review and 2% of total non-duplicative claims for eligible members are approved.
Financial pressures squeezing providers and insurers have fueled some high-profile contract dustups in recent months.
Hospital systems, in quarterly statements, earnings calls and other public comments, have said insurers’ claims processing roadblocks have forced additional administrative costs at a time when inflationary spending has accelerated and government-paid rates remain low. Insurers, beginning last year, took a harder stance on approving payouts as medical utilization rates increased and more claims rolled in. Both sides of the aisle are also staring down likely funding cuts and insurance coverage rates stemming from federal policy.