Department of Financial Regulation Recently, UnitedHealthcare has written to patients to inform them that University of Vermont Health Network providers and facilities in Vermont and upstate New York, including the University of Vermont Medical Center, Central Vermont Medical Center, Porter Medical Center, Alice Hyde Medical Center, Champlain Valley Physicians Hospital, and Elizabethtown Community Hospital, will no longer participate in its commercial insurance provider network as of April 1, 2022. As a result, most non-emergency services will not be covered as an in-network benefit under commercial UnitedHealthcare plans.
The change will not affect members in the following UnitedHealthcare plans:
- Medicare Advantage (including Vermont AARP Medicare Advantage Plans)
- Medicare Supplement (including Vermont AARP Medicare Supplement Plans)
- New York Managed Medicaid
- Veterans Administration Community Care Network
Under federal law, health insurance plans must continue to provide in network rates for individuals who are considered continuing care patients. In general, federal law defines continuing care patients as individuals undergoing treatment for a serious and complex condition. The following continuity of care protections apply when a provider or facility ceases to be an in-network provider because of a termination of a contract:
- Timely notify continuing care patients of the termination and their right to elect continued transitional care from the provider or facility;
- Provide continuing care patients an opportunity to notify the plan or issuer of the need for transitional care;
- Permit continuing care patients to elect to continue their care under the same terms and conditions as would have applied under the plan or coverage had the termination not occurred, with respect to the course of treatment furnished by the provider or facility.
Consumers with additional questions may contact the University of Vermont Health Network at 844-886-4325, or UnitedHealthcare at 800-444-6222.
Additional information may also be found on the University of Vermont Health Network website at https://www.uvmhealth.org/news/uvmhn/important-information-regarding-unitedhealthcare-commercial-insurance.
Consumers may also contact the Department of Financial Regulation at 800-964-1784 or by email at [email protected].
UVMHN Statement
Published March 3, 2022
Please note that Alice Hyde Medical Center (including The Alice Center), Central Vermont Medical Center (including Woodridge Nursing & Rehabilitation), Champlain Valley Physicians Hospital (including Lake Champlain Physician Services and Skilled Nursing Facility), Elizabethtown Community Hospital, Porter Medical Center (including Helen Porter Rehabilitation and Nursing), and The University of Vermont Medical Center will no longer be participating in the UnitedHealthcare (“United”) Commercial Insurance provider network. This means most services provided at The University of Vermont Health Network’s (“UVMHN”) hospitals, outpatient facilities, clinics and provider practices will no longer be covered as in-network benefits under United Commercial plans.
This change does not impact any existing participation status between UVMHN and United for Medicare Advantage, Managed Medicaid and Veterans Administration Community Care Network (“VA CCN”) coverage, which we will continue to accept. Central Vermont Medical Center and Champlain Valley Physicians Hospital will also continue to accept United Behavioral Health coverage.
For a number of years, our ability to provide timely and appropriate care to our patients covered by United Commercial plans has been affected by significant administrative and operational issues. Despite our best efforts to resolve these issues, patients continue to experience unnecessary delays in approvals for common tests, including imaging, treatments and medications among many other challenges.
If you have health insurance through your employer, you should talk to them about your available plan options. For patients that have enrolled in health insurance through non-employer plans, you may wish to elect to change insurers during the next open enrollment period in order to ensure that your care at the UVM Health Network is considered in-network.
The below references answer some frequently asked questions. However, it is advised that patients contact UnitedHealthcare directly to better understand their individual impact based on plan structure.
Frequently Asked Questions – NY Self-Insured, VT Self-Insured and VT-Fully Insured Plans
FAQ
UnitedHealthcare Commercial Contract Non-Renewal
Frequently Asked Questions NY Self-Insured, VT Self-Insured and VT Fully-Insured Plans
Overview
Effective April 1, 2022, Alice Hyde Medical Center (including The Alice Center), Central Vermont Medical Center (including Woodridge Nursing & Rehabilitation), Champlain Valley Physicians Hospital (including Lake Champlain Physician Services and Skilled Nursing Facility), Elizabethtown Community Hospital, Porter Medical Center (including Helen Porter Rehabilitation and Nursing), and The University of Vermont Medical Center’s participation agreement with UnitedHealthcare (“United”) will not be renewed for the Commercial line of business.
Why am I receiving this notice?
Our records show that you have received services at one of our UVM Health Network locations while utilizing a United Commercial insurance plan. Effective April 1, 2022, UVM Health Network providers will no longer be participating in the United Commercial provider network. This means that UVM Health Network affiliates and related entities will no longer accept coverage for patients enrolled in United’s Commercial insurance plans.
What does this mean for me? Do I have to change my health insurance?
If you have health insurance through your employer, you should talk to them about your available options.
For patients that have enrolled in health insurance through non-employer plans, you may wish to elect to change insurers during the next open enrollment period in order to ensure that your care at the UVM Health Network is handled as in-network.
If you are currently receiving care, please refer to the condition specific information outlined below. If you have a question about a condition or treatment not captured below, we recommend you reach out to United for guidance.
What happens if I choose to seek care at a UVM Health Network location on and after April 1, 2022?
If you receive services at a UVM Health Network location beyond this date, United will consider this care as being out-of-network, which could result in increased patient financial liability (i.e. deductibles, co-pays or even full cost).
What do I do if I need a referral to a new specialist that is in-network with United?
Please contact your current provider with the name of your newly chosen provider so they can initiate a referral and send your medical records.
Why are you making this decision now?
For a number of years, our ability to provide timely and appropriate care to our patients covered by United Commercial plans has been affected by significant administrative and operational issues. Despite our best efforts to resolve these issues, patients continue to experience unnecessary delays in approvals for common tests, including imaging, treatments and medications among many other challenges.
Which UVM Health Network affiliates are impacted by the contract non-renewal?
The following affiliates and all related entities are affected:
- Alice Hyde Medical Center (including The Alice Center)
- Central Vermont Medical Center (including Woodridge Rehabilitation and Nursing)
- Champlain Valley Physicians Hospital (including Lake Champlain Physician Services and CVPH Skilled Nursing Facility)
- Elizabethtown Community Hospital
- Porter Medical Center (including Helen Porter Rehabilitation and Nursing)
- The University of Vermont Medical Center
UVM Health Network Home Health & Hospice and Yankee Medical will continue to accept United Commercial insurance.
Are my UVM Health Network providers impacted by the contract non-renewal? Yes, physicians employed by our hospitals, outpatient facilities, clinics and provider practices will no longer participate in the United Commercial provider network.
Are non-commercial United plans (Medicare Advantage, Managed Medicaid, VA Community Care Network) impacted by the contract non-renewal?
No, this decision only affects United Commercial insurance plans.
Are United Medicare Supplement Plans impacted by the contract non-renewal?
No, this decision only affects United Commercial insurance plans.
Are United Commercial Plans that are secondary to Medicare or secondary to a Commercial Plan impacted by the contract non-renewal?
Yes, United Commercial Plans that provide primary or secondary coverage are affected by this non-renewal.
What if I have an emergency after March 31, 2022? You will always have access to our emergency rooms regardless of our contract status with United, and the services should be handled as in-network by United. Always visit the nearest emergency room if you have an emergency.
What will happen if I am in the hospital on March 31, 2022? If you are in the hospital between now and March 31, 2022, your care should be handled as in-network by United until you leave the hospital.
What happens if I am receiving care for pregnancy on March 31, 2022? If you are in your 3rd trimester of pregnancy and your pregnancy is considered low-risk, you may continue to receive care from your provider until the completion of your postpartum follow-up visit. Your remaining care should be handled by United as in-network, however you should contact United to determine if authorization (approval) is needed.
If you are in your 1st, 2nd or 3rd trimester of pregnancy and your pregnancy is considered moderate or high-risk, you may continue to receive care from your provider until the completion of your postpartum follow-up visit. Your remaining care should be handled by United as in-network, however you should contact United to determine if authorization (approval) is needed.
If you are in your 1st or 2nd trimester of pregnancy and your pregnancy is considered low-risk, your care will be handled by United as out-of-network. You may wish to choose a new provider that is covered in-network with United, however you should contact United to determine if authorization (approval) is needed.
What if I have a procedure booked for after March 31, 2022? Please reach out to United for guidance if you currently have an appointment or procedure scheduled at a UVM Health Network location after March 31, 2022.
What if I am receiving home infusion services at The University of Vermont Medical Center? You may continue to receive home infusion services from your provider at The University of Vermont Medical Center as this contract non-renewal does not affect home infusion services.
What if I am receiving non-surgical cancer treatment? You may continue to receive non-surgical cancer treatment from your provider until April 30, 2022 (30 days after contract non-renewal date) or until the completion of radiation or chemotherapy. Your care during this time period should be handled by United as in-network, however you should contact United to determine if authorization (approval) is needed.
What if I am receiving treatment for end stage kidney disease? You may continue to receive treatment for end stage kidney disease from your provider until April 30, 2022 (30 days after contract non-renewal date). Your care during this time period should be handled by United as in-network, however you should contact United to determine if authorization (approval) is needed.
What if I am receiving dialysis treatment? You may continue to receive dialysis treatment from your provider until April 30, 2022 (30 days after contract non-renewal date). Your care during this time period should be handled by United as in-network, however you should contact United to determine if authorization (approval) is needed.
What if I am undergoing active treatment for symptomatic AIDS? You may continue active treatment for symptomatic AIDS from your provider until April 30, 2022 (30 days after contract non-renewal date). Your care during this time period should be handled by United as in-network, however you should contact United to determine if authorization (approval) is needed.
What insurance plans are accepted at the UVM Health Network?
A list of accepted health insurance plans can be found on the websites of each UVM Health Network affiliate.
3.10.2022. Montpelier, VT – Vermont Department of Financial Regulation website.