BALTIMORE — After months of negotiations, UnitedHealthcare and Johns Hopkins have failed to reach a compromise by Monday, causing 60,000 patients to lose their in-network coverage.
“I’m on disability, so I don’t know what to do. It’s like I’m stuck,” Jean Blouse told WMAR-2 News.
Blouse has been diagnosed with Rheumatoid Arthritis, a condition she’s lived with for 30 years, that doctors now believe may be attacking her lungs. Her entire team is at Johns Hopkins.
WATCH: Thousands of patients lose in-network coverage after failed deal
“United Healthcare wants me to pick a new doctor in network. Then I have to wait for appointments with them, wait for appointments with their specialist. So, what am I going to do? Pray I don’t die ahead of time, because I can’t breathe,” she said.
“People don't go to Hopkins because they have a nose bleed. People are going to Hopkins for serious life threatening illnesses, you know, and sometimes ones that only Hopkins in this entire area treats like what I have,” Alecia Knupp said.
Knupp is currently receiving immunotherapy after a diagnosis of pancreatic neuroendocrine cancer.
“I feel horrible. I feel dejected,” she said. “I was very positive about my treatment. Johns Hopkins was very positive about my treatment and my plan and now I'm terrified."
The insurance company says despite trying to find a middle ground, the hospital system has maintained demands that UHC says would harm employers, including discretionary patient denial by the hospital.
Statement from Joseph Ochipinti, UnitedHealthcare CEO, Mid-Atlantic region:
“Johns Hopkins refused to move off contractual terms no other health system in our network requires, including language that would allow it to deny patient access at its discretion. Despite our repeated efforts to compromise and extend our contract to avoid disruption, Johns Hopkins refused. While we remain committed to continued negotiation, our top priority now is providing people with the care they need through continuity of care or a smooth transition to another provider, as appropriate.”
Meanwhile, the healthcare system blames UHC’s excessive prior authorization requirements and frequent treatment denials for the impasse.
Statement from Kim Hoppe, Vice President of Public Relations, Johns Hopkins Medicine:
For more than eight months, Johns Hopkins Medicine has negotiated in good faith with UnitedHealthcare, agreeing to their five requests to extend the contract so that we could reach an agreement that puts patients first.
This is not about money, nor is it about small administrative issues. We are negotiating our contract with United so that we can 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.
Our patients deserve better than insurance company barriers standing between them and their care. We urge UnitedHealthcare to listen to our concerns in a meaningful way and prioritize what matters most: ensuring patients get the care they need, when they need it, at agreed upon reimbursement.
“They make it difficult for the physicians to practice for their patients. So, that's what we're hearing over and over again, and that's one of the frustrations,” CEO of the Maryland State Medical Society or Medchai, Gene Ransom explained.
While both sides have pointed the finger at the other, Ransom believes the blame leans heavily to one side.
“This is just an example of the insurance company being more concerned about their quarterly stockholder report than the patients they insure,” he said.
In the meantime, UnitedHealthcare has encouraged patients to apply for continuity-of-care, which allows them to extend their current coverage, but only in specific cases like active pregnancies or cancer treatment.
But the process has been difficult, time-consuming and not a guarantee. The Maryland Insurance Administration has launched an investigation into UHC’s continuity of care practices due to its departure from both Hopkins and most recently, Capital Women’s Care
An In Focus look at another out-of-network negotiation that failed for UnitedHealthcare
Knupp says she spent 4.5 hours last week starting the process, just to find the right forms.
“It was in a place that no one would ever look. And I mean, I’m fairly technologically savvy, so I just wonder about people that don't have my chart or aren't on the computer every day all the time.You know, how are they to navigate this?” Knupp said.
She is still waiting to hear back, as she debates whether she can go to her appointment this week.
So is Blouse, who says her infusion treatment she receives every 8 weeks costs upwards of $36,000 out of pocket.
If you are affected by the change and are denied any continuing care, Ransom says you should file a complaint with the MIA.
You can do so here.
Consumers can also contact the MIA at 410-468-2244 or 1-800-492-6116, Extension 2244 to learn more about their rights under state and federal law.