Vermont’s largest health care provider says that — once again — it is being dropped from the nation’s largest health insurance company, effective April 1.
UnitedHealthcare threatened to drop UVM Health Network patients last year. That plan was averted when the two organizations negotiated an agreement to ensure that Vermonters and New Yorkers insured by UnitedHealthcare had access to the UVM Health Network, which includes its flagship hospital in Burlington.
Now, the contract dispute between UnitedHealthcare and UVM Health Network threatens to leave some 2,600 residents of Vermont and New York in limbo once again.
Among them is Eliza Graves, who has survived a year of chemotherapy, radiation and massive surgery to treat her cancer and has a scheduled CT scan next week. While she waited to see whether the insurer and the health network would reach an agreement last year, and to ensure continuity of care in the meantime, she drove 90 minutes each way from her home in Jericho to Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, for her weekly chemotherapy — for six months. She lived in Boston for five weeks for her radiation, and that is where she underwent surgery, as well.
She now has a UVM Medical Center oncologist she loves, but will not be able to see as a result of the new dispute.
“I just can’t believe that I’m back at this situation,” she said on Tuesday. “I was stunned when I was sent the email today.”
Graves obtained an internal email that had been sent to UVM Health Network employees from the network’s chief executive officer, Dr. Sunil Eappen, announcing that UnitedHealthcare had decided to terminate its commercial insurance contract. The decision affects only insurance bought by employers or individuals. It does not affect Medicare Advantage patients or veterans.
“This will have a serious impact on our patients who subscribe to UnitedHealthcare’s commercial insurance,” Eappen said in an email to VTDigger, “and we are disappointed they have made this decision rather than attempt to come closer to payment rates approved by the Green Mountain Care Board that more accurately reflect the cost of providing health care in 2023 and align with rate increases negotiated with other Vermont payers.”
UVM Health Network said it offered UnitedHealthcare a contract that would have kept patients covered until the end of 2023, but the insurer turned that proposal down.
In an emailed statement, UnitedHealthcare said UVM Health Network was asking for more than the rates approved by the Green Mountain Care Board.
“Despite receiving a nearly combined 20% increase in reimbursement rates over the last three years, UVMHN is now proposing a more than 15% price hike in one year,” UnitedHealthcare spokesperson Cole Manbeck said.
He said UnitedHealthcare remains committed to continuing negotiations and working out plans for continuity of care for pregnant patients and patients with cancer. The insurer said it would continue to cover emergency care at UVM Health Network.
Graves was unmoved by official statements from either side, saying they should have spent “the last year working on a compromise to protect their members.”
“But clearly, we weren’t a priority,” she said. “I know that UVM (Health Network) wants all the blame to fall on UnitedHealthcare, but it’s a two-way street, and they know how many patients they have that are stuck with UnitedHealthcare.”
Graves said UnitedHealthcare is the only health insurance offered by her husband’s employer. She calls the situation “morally wrong.”
“It should be completely illegal,” she said. “I don’t understand how the Green Mountain Care Board and the Vermont Legislature can be OK with this.”
UVM Health Network has set up a webpage for patients covered by UnitedHealthcare.
UVM Health Network reported $90 million in losses in 2022. The network includes UVM Medical Center, Central Vermont Medical Center, Porter Medical Center in Middlebury, and three hospitals in New York: Alice Hyde Medical Center, Champlain Valley Physicians Hospital and Elizabethtown Community Hospital.
UnitedHealthcare reported a $14.4 billion profit for 2022.
In September, the Green Mountain Care Board approved insurance rate increases of 14.77% for UVM Medical Center, 12.5% for Central Vermont Medical Center and 11.5% for Porter Medical Center.
Al Gobeille, executive vice president at UVM Health Network, said labor is the biggest driver of increased cost of care, but pharmaceuticals and medical supplies also factor in.
Gobeille said UnitedHealthcare’s last best offer would have increased payments by a percentage “in the low single digits.”
Unless UVM Health Network and UnitedHealthcare reach an agreement, Vermonters will lose their in-network health care coverage April 1 and New Yorkers on June 1, which means their costs will increase significantly.
“We offered this year to allow the plan to continue with no increase to the end of this calendar year,” Gobeille said. “That way, it wouldn’t hurt patients or providers, and United turned that down. If United wants to get together and talk about this, we’re 24/7 willing to meet them.”
Graves said if the insurer and the health network do not reach an agreement, she would have to drive to Boston for her follow-up care, a nearly five-hour drive each way with traffic, as she does not have an oncologist at Dartmouth Hitchcock.
“I’ve worked so hard to stay alive,” Graves said. “You’d think Vermont could make it a little bit easier for me.”