After more than a year of negotiations, Vermont’s largest health care provider and a national health insurer have failed to reach a deal, leaving more than 2,500 people in the region to find an alternative.
UVM Health Network officials said Monday in a statement that efforts to renegotiate a contract for payment with the nationwide for-profit insurer UnitedHealthcare have ended, meaning its six hospitals and their affiliates will no longer be “in network” providers. The two parties, who have long been at loggerheads, agreed to extend their current arrangement through February 2024 — otherwise, it would end in December — giving affected patients two additional months to either change insurers or change providers.
UnitedHealthcare confirmed both the impasse and the extension of the current contract in an email.
“We have been unable to come to an agreement with UVMHN that is affordable or sustainable for Vermonters, New Yorkers and employers,” wrote Cole Manbeck, director of corporate communications for the company, which provides health insurance to more than 46 million Americans.
UnitedHealthcare representatives said in March 2022 that the company could not accept the close to 10% increase in prices that the UVM Health Network was seeking at the time.
The health network —- including University of Vermont Medical Center in Burlington, Central Vermont Medical Center in Berlin and Porter Medical Center in Middlebury, as well as three New York hospitals — argued then and now that it needs the higher payments to cover higher staffing and other costs.
The Green Mountain Care Board recently approved a maximum 3.1% increase in overall charges for the University of Vermont Medical Center, the network’s largest hospital, in fiscal year 2024, which started Oct. 1. However, an annual increase of up to almost 15% was allowed for fiscal year 2023.
The end of the contract between the two organizations will affect only someone who is enrolled with UnitedHealthcare through an employer-offered plan or a plan purchased directly from the insurer.
It will not impact anyone who is insured by the company through a Medicare Part C plan, a Veterans Affairs plan, a Medicaid managed care plan or a plan purchased through a state marketplace, both organizations confirmed. The latter two types of plans are not available to Vermonters.
People who have purchased Medicare Supplement plans, often called Medigap, from UnitedHealthcare also will not see any change to their coverage.
Even for commercial plans, behavioral health services will remain available at “in network” prices through Central Vermont Medical Center and Champlain Valley Physicians Hospital in Plattsburgh, New York, as will at-home infusion therapy through UVMMC.
Every month that the old contract with UnitedHealthcare continues creates financial pressure on the network, UVM Health Network Chief Financial Officer Rick Vincent said in the statement.
“We are taking on additional financial losses to give our patients extra time to secure alternative coverage if they need it, and for employers to ensure that their employees have plan options that allow them to get the care they need here in Vermont and northern New York,” he said.
Without a contract in place, the hospitals and providers within the UVM Health Network cannot bill UnitedHealthcare. For non-emergency services, patients would be generally charged a much higher out-of-network rate directly and, depending on the details of the insurance plan, may not get any of the cost reimbursed.
Earlier this year, the Vermont Department of Financial Regulation provided a fact sheet for people insured by UnitedHealthcare. The department noted that the 2021 federal No Surprises Act, which went into effect last year, may offer additional rights to patients who are receiving ongoing treatment for complex conditions at the end of the contract. Those conditions include cancer, pregnancy or end-stage renal disease.
Manbeck said that UnitedHealthcare is “committed to collaborating with UVMHN to ensure the people we serve have access to the care they need through either continuity of care or a smooth transition to a new provider over the next several months.”
Clarification: This story has been updated to clarify the status of Medicare Supplement plans and other “in network” healthcare services that will remain available after the contract ends between University of Vermont Health Network and UnitedHealthcare.
