Jefferson Health to End Contract with United Healthcare

On Monday, Jefferson Health revealed that it plans to terminate its contract with both Lehigh Valley Health Network (LVHN) and United Healthcare. They argue that United, the largest insurer in the U.S., has been paying lower rates than initially agreed upon for several years.

LVHN, which is merging with Jefferson Health in 2024, stated that its contract with United is currently valid until January 25, 2026, for Medicare Advantage patients, and April 25, 2026, for those with commercial insurance through employers.

This decision could result in higher out-of-pocket expenses for many patients next year, a situation that has raised concerns.

Dr. Edmund Privitkin, chief physician executive for Jefferson Health, expressed frustration in a video saying, “Lehigh Valley Health Network, now a part of Jefferson Health, has sought to build a fair partnership with UnitedHealthcare for over two years. Unfortunately, our attempts have faced numerous delays and challenges as United continues its unfair payment practices.”

Privitkin stated that United has not adhered to the agreed payment rates since 2021, leading to compensation that was about 40% lower than expected.

He added, “Our aim is to create a just relationship with United that offers fair reimbursement, benefiting patients and enabling LVHN to maintain high-quality care, no matter the insurance provider.”

Despite this, United will still be an in-network provider for other Jefferson Health services in the Philadelphia area.

LVHN operates 15 hospitals along with numerous clinics, rehabilitation facilities, and outpatient services across 10 counties in Pennsylvania.

Notable hospitals under LVHN include:

• Lehigh Valley Hospital – Cedar Crest, Allentown
• Lehigh Valley Health Network – Allentown, Tillman
• Lehigh Valley Health Network – 1503 N. Cedar Crest, Allentown
• Lehigh Valley Hospital – Allentown 17th Street
• Lehigh Valley Hospital – Muhlenberg, Bethlehem
• Lehigh Valley Health Network – Highland Avenue, Bethlehem
• Lehigh Valley Hospital – Dixon City
• Lehigh Valley Hospital – Hecktown Oaks, Easton
• Lehigh Valley Hospital – Pocono, East Stroudsburg
• Lehigh Valley Hospital – Gilbertsville
• Lehigh Valley Hospital – Hazleton
• Lehigh Valley Hospital – Carbon, Lehighton
• Lehigh Valley Hospital – Macungie
• Lehigh Valley Hospital – Schuylkill E. Norwegian Street, Pottsville
• Lehigh Valley Hospital – Schuylkill S. Jackson Street, Pottsville

A spokesperson from United claimed that LVHN and Jefferson’s statements are “misleading and possibly false” and suggest that this could be a strategy to influence negotiations.

According to UnitedHealthcare, they received notice from LVHN regarding the potential termination of their contract, which is currently under review. United submitted a new proposal to LVHN in April, but no counteroffer has been made yet.

They added that the final proposal included a nearly 30% rate increase for the first year of the contract.

The spokesperson said, “Lehigh Valley’s statements seem aimed at the annual Medicare enrollment period, likely as a negotiation tactic. We urge them to engage in productive discussions rather than exploiting consumers, which could drive healthcare costs up for Pennsylvanians and local businesses.”

Last month, it was also reported that Johns Hopkins School of Medicine ended its contract negotiations with United, impacting thousands of patients in Maryland, Virginia, and Washington, D.C., who lost in-network insurance access.