September 1st 2024.
In a last-minute turn of events, HealthOne and UnitedHealthcare have reached an agreement that will keep the hospitals in-network. This means that patients will not have to find new doctors or worry about paying more out-of-pocket. When a patient visits a hospital that has agreed to in-network rates, they are either charged a flat fee or a percentage of the cost of their care. However, if they go to an out-of-network facility, they may receive a bill for the portion that their insurance does not cover. While federal and state laws protect patients from surprise bills in emergency situations, they do not apply to scheduled care.
According to United spokesperson Cole Manbeck, the two parties have reached a multi-year deal that guarantees continued access to HealthOne's hospitals, facilities, and physicians for those enrolled in employer-sponsored commercial plans, individual family plans, and Medicare Advantage plans. This includes group retiree and dual special needs plans. In a news release, Manbeck expressed gratitude towards members and customers for their support and patience throughout the negotiation process. The news release also stated that they are committed to providing quality and affordable healthcare to the people of Colorado.
The previous contract between the two businesses ended on Sunday, and negotiations for the next contract were proving to be difficult. If an agreement had not been reached, patients covered by United would have had to pay more to use the following hospitals: Centennial Hospital, North Suburban Medical Center, Presbyterian/St. Luke's Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, and The Medical Center of Aurora. United claimed that HealthOne was making unreasonable demands for double-digit rate increases, while HealthOne argued that United was offering rates below market levels for the Denver area.
It is not uncommon for health systems and insurers to reach an agreement before their contracts expire. However, earlier this year, CommonSpirit Health and Anthem BlueCross BlueShield of Colorado were unable to agree on rates and CommonSpirit left the network for over two weeks. This can have a significant impact on patients and providers alike.
According to Becker's Healthcare Review, there were at least 20 disputes between hospitals and insurance companies nationwide in the second quarter of 2024, compared to at least 24 in the same period of 2023. However, the actual number may be higher as this data is based on news reports and some disputes may have been resolved quietly or in areas without local media coverage. Additionally, approximately 30% of these disputes did not result in an agreement before the contract expired, leading to hospitals being out of network for at least a brief period of time.
It is worth noting that United is the largest insurance company in the commercial and Medicare Advantage markets nationwide, while HCA Healthcare, the owner of HealthOne hospitals, is the largest for-profit health system in the country. This highlights the importance of reaching an agreement that is fair for both parties, as it impacts the care of millions of patients across the country. Reporter Noelle Phillips also contributed to this report.
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