Health insurance

Health insurance giant now says coverage for 5,000 Vermonters is at risk in contract dispute

The University of Vermont Medical Center in Burlington. File photo by Glenn Russell/VTDigger

Many more Vermonters than initially thought are at risk of losing the services offered by the University of Vermont Health Network if the state’s largest health care provider fails to reach an agreement with UnitedHealthcare, the country’s largest insurer by Friday.

State officials previously estimated, based on information provided by UnitedHealthcare, that 1,800 Vermonters were at risk. But Michael Pieciak, commissioner of the state’s Department of Financial Regulation, told VTDigger on Monday that UnitedHealthcare has since clarified that this is the number of Vermonters who have sought medical care in the past year at UVM Health Network. UnitedHealthcare actually covers 5,000 Vermonters who receive care from UVM providers, he said.

Only Vermonters insured under UnitedHealthcare’s employer-provided plans are affected by the insurer’s dispute with UVM Health Network. The fight does not include supplemental Medicare plans or veterans health insurance plans.

Vermont officials said Monday they hope the two sides are close to an agreement.

“I’m very optimistic that this is going to be resolved within 48 hours,” Kevin Mullin, chairman of the Green Mountain Care Board, told VTDigger.

Mullin said he wrote to both parties earlier this month urging them to come to an agreement.

The Green Mountain Care Board has jurisdiction over health care plans offered on the state exchange, Vermont Health Connect, and monitors hospital budgets and the fees they charge, but it has no jurisdiction over UnitedHealthcare employer-provided plans, which are federally regulated.

Pieciak said Monday he was “optimistic this will be resolved.”

UnitedHealthcare wrote to at least some patients last month that it would stop considering UVM Health Network as an in-network provider starting April 1 because the two organizations could not agree on the fees the insurer would reimburse the network. health.

Leah Lotto, a Burlington resident, said she didn’t receive that letter until she found out about the changes when a UVM Health Network representative recently told her on the phone that her care would no longer be covered after Thursday.

Lotto had just completed radiation therapy for cancer when she spoke to VTDigger on Monday. The treatments were to last four more weeks.

“I have a whole bunch of other cancer-related treatments scheduled and planned,” Lotto said. “And I don’t know if those will be covered.”

Lotto’s 5-year-old child is also covered by his insurance plan.

“I understand we can’t even try to get ongoing care for him,” Lotto said. “So we have to find something else for him.”

Under unsurprising federal law, health insurers must provide certain types of coverage a patient has already started receiving — called continuing care — for 90 days after a contract with a health care provider ends.

Pieciak said he’s been in touch with UnitedHealthcare to find out what the insurer would be willing to do for patients beyond its 90-day obligation. He said the company was willing to work out coverage plans with patients who contacted him.

Pieciak said his office has heard of patients who fear losing doctors and other providers they’ve seen for years, even decades. He’s also heard from employers that it’s hard to recruit employees if health insurance doesn’t include the state’s largest healthcare provider.

Vermont’s leading healthcare advocate, Mike Fisher, told VTDigger that his office has received calls from many Vermonters “who are really hurt by this” and worried about losing their relationships with their providers.

Mullin said UnitedHealthcare should have informed employers much sooner that it would no longer cover UVM Health Network within its network.

“Vermonters are caught like pawns between two giant health care providers,” Mullin said.

UnitedHealthcare did not respond to a request for comment Monday regarding its negotiations with UVM Health Network. A spokesperson for the health network declined to comment on the talks.

Lotto said she understands the 90-day provision under federal law would only cover her radiation treatments.

She said she was frustrated not only by her possible loss of coverage, but how she found out in mid-March. She was trying to schedule a physiotherapy appointment for the following month, she said, but was told she couldn’t because her insurance would no longer cover it. When she asked if it was for physical therapy only, she was told, “No. Any UVM will no longer take UnitedHealthcare.

Lotto said she had this conversation with UVM Health Network on the afternoon of March 18 – just days before her radiation treatments began.

“Very strange and terrible news to receive and it seemed like it couldn’t be true,” Lotto said.

She said she had not heard from UnitedHealthcare if they would cover her treatments beyond Thursday.

“Could you tell me right now that I won’t have to pay for this treatment I need to start?” she said she asked a UnitedHealthcare representative. “And they didn’t tell me anything.”

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Filed under:

Health care

Tags: Department of Financial Regulation, Green Mountain Care Board, healthcare, Kevin Mullin, Michael Pieciak, Mike Fisher, UnitedHealthCare, University of Vermont Health Network, University of Vermont Medical Center, Health Network UVM health

Fred Thys

About Fred

Fred Thys covers business and economics for VTDigger. He is from Bethesda, Maryland, and graduated from Williams College with a degree in political science. He is the recipient of the Radio, Television, and Digital News Association’s Edward R. Murrow Award for Investigative Reporting and Corporate Reporting. Fred has worked for The Journal of Commerce, ABC News, CBS News, CNN, NBC News and WBUR, and has written for Le Matin, The Dallas Morning News and The American Homefront Project.

E-mail: [email protected]

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