Concerns at Johns Hopkins and UnitedHealthcare

Recently, tens of thousands of patients at Johns Hopkins Medicine and UnitedHealthcare received some unexpected news.

It appears that patients might face challenges using their insurance for upcoming appointments at Hopkins facilities.

This situation stems from ongoing negotiations between Johns Hopkins, a renowned hospital system based in Baltimore, and UnitedHealthcare, one of the largest insurance providers in the country. They’re currently trying to navigate issues related to reimbursement procedures. It’s complicated; there are various aspects in play, including service approvals and related issues.

Despite the challenges, both parties have expressed a desire to maintain their relationship to ensure that patients can continue seeing their doctors.

The deadline for reaching an agreement is August 25th. If a resolution isn’t found, patients from five Hopkins hospitals and associated offices mainly in Maryland could find themselves out of the UHC network.

UHC indicated that this situation could impact employers, Medicare Advantage, Medicaid, and those with individually purchased plans.

In a statement, Johns Hopkins shared that the negotiations have dragged on for seven months.

They expressed concern that “Unfortunately, UnitedHealthcare has recently chosen to delay negotiations because it refused to accept harmful practices that hurt patients.” This includes delaying care and imposing burdensome charges that affect patients’ ability to receive timely treatment.

Negotiations of this kind are not uncommon between healthcare providers and insurance companies. Typically, they involve discussions around service rates and approval processes to help manage costs.

In this instance, both Hopkins and UHC had previously agreed on the fees for medical services.

A related dispute occurred last year with CareFirst, Maryland’s largest insurer, but they managed to resolve their differences before the deadline.

It’s worth noting that these contracts specifically pertain to medical professionals. In Maryland, hospital fees set by insurance companies are regulated by the state, which is why patients often receive multiple bills.

A week ago, UHC sent a letter to nearly 60,000 Hopkins patients notifying them of the ongoing negotiations. Shortly after, Hopkins informed about 65,000 UHC patients who had appointments soon or had seen their doctors within the past year. Most of these patients are located in Maryland, with some in Virginia and Washington, D.C.

Importantly, Hopkins facilities in Florida won’t face any impact from this situation.

Joseph Ochpinty, the CEO of UHC in the Mid-Atlantic region, stated that the company remains committed to negotiating.

He mentioned, “Our negotiations are not about money. We have reached an agreement on financial terms. However, Johns Hopkins requires contractual provisions that will negatively affect members and employers and could ultimately alienate patients.”

For now, patients are advised not to take any action. Both Hopkins and UHC will continue to provide updates on the negotiations.

If Johns Hopkins is removed from the network, UHC indicated that patients can still receive care from Hopkins providers for serious or complex conditions, such as cancer treatment and pregnancy care, though it may necessitate continuity of care.