Extension Allows Commercial Insurance Plan Members Additional Time To Determine Alternative Care Or Medical Coverage Options
Vermont Business Magazine The University of Vermont Health Network will remain in-network for UnitedHealthcare commercial insurance plans through the end of the 2023 calendar year as part of a recent agreement between the non-profit health system and one of the nation’s largest insurance carriers. UnitedHealthcare announced in February that it would let the UVMHN contract expire April 1. Their policy holders would then have to get treatment as out-of-network patients and pay higher rates or go to a different provider. UVMHN said it will take a financial hit because of the deal and it doubts that an agreement will be reached for 2024.
UnitedHealthcare has had a contentious relationship with both UVMHN (over rate reimbursement) and the State of Vermont (advertising). Despite being one of the largest health insurance and Medicare insurance companies in the US ($249.7 billion in revenues in 2022), UnitedHealthcare has a relatively small footprint in Vermont. However, many of those patients are within UVMHN's care region in Vermont and Northern New York.
UnitedHealthcare has more than 2,600 commercial members in Vermont (about 1,900) and northern New York, who would have been "out of network (with certain exceptions)" without the extension. Federal law requires that Unitedhealthcare continue care for patients undergoing treatment for conditions such as cancer, as well as those who are pregnant, even if the contract expired next week.
This extension agreement will allow affected patients additional time to identify alternative medical insurance coverage or health care options starting with their 2024 plan year.
UnitedHealthcare has stated that the rates the hospital was charging patients was too high. UVMHN said the rates were approved by the Vermont regulator, the Green Mountain Care Board.
Who does this impact?
Only Commercial UnitedHealthcare plans, such as those provided by employers or purchased directly, are affected by this extension agreement through December 31, 2023, and expected subsequent termination.
The following plans have NOT been impacted by these renewal negotiations:
- Non-Commercial UnitedHealthcare plans managed by the state or federal government – such as Medicare Advantage, Managed Medicaid, VA Community Care Network
- United Medicare Supplement plans
- United Behavioral Health plans
- The Empire Plan for New York State Employees
“We’re glad that United has agreed to extend this coverage for the remainder of 2023 to help give our patients the time they need,” said Sunny Eappen, MD, MBA, President and Chief Executive Officer of the UVM Health Network. “This situation has caused much stress and anxiety for our patients and we hope this extension helps to ease some pressure in the face of a frustrating situation. We would like to thank everyone who has been supportive of our patients and our health system throughout this process, especially our community members and state and federal government leaders.”
What does this mean for those who are UnitedHealthcare Commercial Plan members?
As part of this extension agreement, UVM Health Network will remain in-network for all patients covered by United Commercial Insurance plans through December 31, 2023. Based on conversations with United to date it is not likely we will continue to be in-network in the 2024 plan year, despite our best efforts to come to a fair agreement.
Patients or employers who are affected may use this additional time to identify insurance options that keep UVM Health Network in-network post December 31, 2023, or work with their health care provider to transition to an alternative in-network option.
As a safety net provider, the UVM Health Network will always provide emergency care to anyone who walks through the door, regardless of what insurance they have or whether they have insurance at all.
For information specific to insurance coverage, affected patients should contact UnitedHealthcare directly. Additional UVM Health Network-specific information may be found at UVMHealth.org/UnitedHealthcare.
Additional Information
- The extension agreement with United does not include any increases and maintains the same rates from the 2022 fiscal year contract, which will have a negative impact on the Network’s finances.
- Nationally, hospitals continue to struggle under increased expenses of providing care, while many of the nation’s largest insurers continue to post profits in the billions.
- As a nonprofit organization, the UVM Health Network does not distribute funds to shareholders, and any operating margin earned goes directly back into paying staff, purchasing up-to-date equipment, and investing in top-tier facilities that patients deserve.
Despite the financial impact, UVM Health Network leaders said the extension is meant to support patients as part of the Network’s non-profit mission. “Our health system is a trusted part of our communities throughout Vermont and northern New York,” Eappen said. “While we have to do everything we can to stay financially solvent, our priority has been to do our part to minimize disruption for those seeking care.”
Senators Bernie Sanders and Peter Welch and Representative Becca Balint praised today’s announcement by the University of Vermont Health Network (UVMHN) and United Healthcare (UHC) that UVMHN will remain in UHC’s provider network through the end of the 2023 plan year. The announcement follows a March 10th letter from Sanders, Welch, and Balint, who called on United and UVMHN to reach an agreement to maintain consistent coverage for Vermonters.
“We are relieved that Vermonters with health insurance through United will be able to keep seeing their UVMHN providers for the rest of the plan year,” the lawmakers said in a joint statement. “But Vermonters deserve more. No one should have to travel far from home for care during a medical emergency or wonder if their necessary care will be covered in their home state. We will continue to work together to ensure that every Vermonter has access to stable, affordable, and high-quality health care.”
UVMNH runs the state’s only tertiary care and level-I trauma center, its only neonatal and pediatric intensive care units, and employs hundreds of the state’s leading specialists and health care providers. As one of the nation’s largest health insurers, United Healthcare currently insures– and will continue to insure– thousands of Vermonters.
To read the lawmakers’ letter, click here.
About The University of Vermont Health Network
The University of Vermont Health Network is an integrated system serving the residents of Vermont and northern New York with a shared mission: working together, we improve people’s lives. The partners are:
- The University of Vermont Medical Center
- The University of Vermont Health Network Medical Group
- The University of Vermont Health Network – Alice Hyde Medical Center
- The University of Vermont Health Network – Central Vermont Medical Center
- The University of Vermont Health Network – Champlain Valley Physicians Hospital
- The University of Vermont Health Network – Elizabethtown Community Hospital
- The University of Vermont Health Network – Porter Medical Center
- The University of Vermont Health Network – Home Health & Hospice
3.24.2023. Burlington, Vt. – The University of Vermont Health Network
