As of press time Monday, Dec. 31, Duke LifePoint hospitals Haywood Regional Medical Center in Clyde, Harris Regional Hospital in Sylva and Swain Community Hospital in Bryson City were still in negotiations with UnitedHealth as the Jan. 1, 2019 deadline loomed. If a contract renewal isn’t announced by Jan. 1, UnitedHealth policyholders will be considered out-of-network at those hospitals and will be subject to higher costs for most services.
“Over the past few months, our organization has been working in good faith with UnitedHealthcare to negotiate a new, fair contract for hospital services. We are disappointed that we have been unable to reach an agreement that will allow us to meet patients’ needs today and in the future,” said Harris/Swain spokesperson Lucretia Stargell. “As a result, Harris Regional and Swain Community Hospital’s employed physicians’ services are considered ‘out-of-network’ with UnitedHealthcare beginning January 1, 2019. Today, UnitedHealthcare pays Harris Regional and Swain Community Hospital below market average for physician services. Our current agreement with UnitedHealthcare is simply not sustainable. Our goal in working with UnitedHealthcare is to secure a rate that allows for continued reinvestment in patient care, enhanced services and facilities, recruitment of new physicians and caregivers, and planning for our community’s healthcare future.”
According to a joint press release from the hospitals sent out in mid-October, contract negotiations would focus on securing a rate that “allows for continued reinvestment in patient care, enhanced services and facilities, recruitment of new physicians and caregivers and planning for our community’s future.”
UnitedHealthCare spokesperson Cole Manbeck told a different story, alleging that Duke LifePoint has been stalling negotiations in a way that will prove harmful to UnitedHealthCare members.
“We provided Duke LifePoint a comprehensive proposal for the physicians impacted by this negotiation more than two months ago,” Manbeck said. “Unfortunately, Duke LifePoint has chosen to put our members in the middle of this and has stalled our negotiation efforts for months, failing to provide us a single proposal or inform us what they are seeking in this negotiation.”
The contract issue applies only to physicians employed by Duke LifePoint, not to the hospitals themselves. Emergency room care would still be covered, as would services performed in the hospital by doctors who have privileges at the hospitals but are not Duke LifePoint employees.
While Manbeck said in October the contract issue applies to Duke LifePoint hospitals in general, the joint statement from Harris, Swain and Haywood said that each hospital has an individual contract with United and that they can’t provide information about contracts other hospitals may have with the company. The hospitals also declined to state what percentage of market value United is currently paying physicians, how long the hospitals have been in network with United or what proportion of patients use United.
When asked who will be responsible for renegotiating the contract — hospital CEOs or someone at Duke LifePoint headquarters — the hospitals responded that “our hospital leaders are working with the appropriate leaders to negotiate a new contract.”
Just because the Jan. 1 deadline has passed doesn’t mean the hospitals and the insurance company won’t continue to negotiate a contract. It’s not the first time a major insurer and a hospital have battled it out for a better contract deal.
Mission Health sent out a similar notice to its patients in July 2017 stating that it would terminate its contract with Blue Cross Blue Shield of North Carolina “if ongoing negotiations fail to reach an agreement.” The announcement launched months of back-and-forth between the two organizations, and the Oct. 5 deadline came and went without a resolution. Blue Cross Blue Shield was out-of-network at Mission until a new agreement was finally reached Dec. 15. Mission Health does have a current contract with UnitedHealthCare.
“We remain committed to reaching a solution, so our patients can continue to receive ‘in-network’ access to the care they need by the providers they know and trust. We know this is an inconvenience for patients, and we are working to help them understand their options,” Stargell said.
For more information from Harris, call 828.586.7888, option 3.