BALTIMORE — It's been a month since UnitedHealthcare and Johns Hopkins severed their in-network relationship, leaving thousands of patients in Maryland uncertain about their healthcare coverage. The two healthcare giants remain locked in a contract dispute with no resolution in sight as open enrollment approaches.
On Aug. 25, around 60,000 UnitedHealthcare members lost in-network access to their Johns Hopkins doctors, care teams and specialists. The hospital system said after eight months of negotiations, they couldn't find common ground.
"UnitedHealthcare refused to agree to reasonable contract language, instead insisting that we agree to terms that would make it difficult for us to provide patient care. UnitedHealthcare had the opportunity 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, without excessive delays or denials. Unfortunately, they chose profits over patients. We decided to make patients aware of this stalemate now, to provide our patients and their employers the time they need to explore alternative insurance options during the upcoming open enrollment season."
UnitedHealthcare disputes those claims. The company says it was preparing to send a counter proposal on Sept. 15.
“Johns Hopkins informed us it walked away from our negotiation because we will not agree to language that allows it to refuse treatment for any member with an employer-based plan it does not want to do business with. Johns Hopkins’ demands are not acceptable. We will not allow any health system to turn patients away at their discretion. We expect network providers to honor their commitment to care for the individuals and families who rely on them as in-network providers. A provider who selectively turns patients away—regardless of medical need or coverage— undermines the foundation of what it means to be a network provider. We remain at the negotiating table and ask Johns Hopkins to do what’s right for the people we serve by providing access to care for all patients.”
Meanwhile, members like Julie Wigley, WMAR-2 News' Assistant Creative Services Director, are stuck waiting.
"I am living with MS, so I have an autoimmune disease that I've been dealing with since 2010," Wigley said.
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She filed continuity of care requests, which were approved, giving her and other patients with serious or complex conditions 90 days of coverage. But it's unclear what happens next.
"Our number one priority is to make sure that Maryland consumers are not caught in the middle between these two giants," said Maryland Insurance Commissioner Marie Grant.
Grant says her office can't force a deal, but they're investigating the adequacy of United's networks without Johns Hopkins Health System and Capital Women's Care.
"They need to have adequate providers that can see Marylanders for all kinds of conditions, whether that be for things like pregnancy and childbirth or serious medical and rare conditions," Grant said. "But that all being said, I think one of the things that we're learning, unfortunately, from this situation is that there may be places where Maryland law can be updated."
And she's recently had conversations about reforms ahead of Maryland's next legislative session.
"I will say that I've been in touch with legislators and the Attorney General.Nothing I can report out definitively at this time, but I think there is broad interest across the board in making sure Marylanders are protected," Grant added.
She's seeking better notice to regulators and consumers, and she's looking to other states for ideas, like Connecticut, where a 60-day cooling off period kept patients in-network 60 days after a major contract ended. The sides reached a deal within that window.
"Maryland doesn't see these kinds of disputes very often and, in part, that's because our rate regulation for hospitals. There's not necessarily as much to fight about in Maryland when rates are set between big hospital systems and insurers," Grant said.
What consumers can do is look ahead to open enrollment and shop around.
"If you have options, we want to make sure that you're looking at not just the costs of the plan, right, the premiums, out of pocket, but that you're looking at who's in network, what are your medical needs now, and also what your medical needs might be in an emergency," Grant said.
Click here to access Maryland Insurance Adminstration resources and tools when shopping for health insurance.
If a new contract isn't reached before open enrollment, Grant says to base your decision on the current status, not what could happen later. If you're facing coverage denial or need help navigating your plan, her office can assist and you can expect to hear back within a week or two. To contact the Maryland Insurance Administration, call 410-468-2244 or 1-800-492-6116, extension 2244. Or click here for information on how to file complaint with the agency.
UnitedHealthcare added that continuity of care requests are approved for a minimum of 90 days and could be longer depending on the course of treatment. Members should always go to the nearest hospital in the event of an emergency and services will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare's network.
UnitedHealthcare is still in talks with Capital Women's Care after the agreement terminated August 1.
"We delivered a new proposal to CWC on Sept. 19. Our proposal includes additional compromises as well as meaningful rate increases. We urge CWC to finalize the terms of our latest proposal or provide a counter that is affordable for consumers and employers," Ochipinti said.
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