- Ascension Wisconsin and United Healthcare couldn’t come to an agreement after several months of contract talks.
- Consequently, Wisconsin providers will no longer be included in the UnitedHealthCare insurance network.
Ascension Wisconsin is no longer part of UnitedHealthcare’s patient network, as both sides failed to finalize a new contract.
For months, they found themselves at an impasse regarding payment rates, each blaming the other for the stalled negotiations as the October 1st deadline approached.
“Despite our best efforts, we couldn’t find terms that reflect the increasing costs of care in today’s climate,” said Ascension Wisconsin spokesperson Mo Moorman.
“We understand this change is difficult and might be worrying for our patients. We are dedicated to helping those affected understand their options and ensure they can still get the care they need,” the statement added.
This development means patients might face hard decisions, like switching doctors or opting for different health plans.
UnitedHealthCare stands as the largest health insurance provider in the nation. Ascension, based in Missouri, has a significant presence in southeastern Wisconsin and Fox Valley.
Patients insured by UnitedHealthcare receiving care at Ascension Wisconsin hospitals, outpatient centers, and doctor’s offices will be impacted, according to the statement from Ascension.
Some patients might still see their doctors for a limited period at network costs. They should reach out to UnitedHealthCare about “continuity of care.”
The Federal Centers for Medicare and Medicaid Services outlines that certain patients can qualify:
- Treatment for serious and complex illnesses
- Institutional or hospitalized care
- Upcoming non-selective surgery
- Pregnant patients receiving treatment
- Those with terminal illnesses
Ascension Wisconsin is advising patients with UnitedHealthcare to explore other health plans during the open enrollment period this fall.
In a communication to patients prior to the October 1 deadline, UnitedHealthcare recommended some members seek new doctors within their new network for continued care at a lower cost.
This contract dispute goes beyond payment rates. Health insurance companies and hospital systems routinely negotiate reimbursement rates for services.
UnitedHealthcare accused Ascension Wisconsin of requesting “unsustainable price hikes” and looking for a fair contract that would properly reimburse hospitals and clinics.
“The proposed reimbursement rates from UnitedHealthcare do not sufficiently acknowledge the significant financial challenges faced by healthcare providers, including soaring inflation and rising costs for equipment and medications,” a Wisconsin statement indicated.
On the other hand, UnitedHealthcare asserted they proposed a “market-competitive fee” designed to address escalating premiums and out-of-pocket costs, aiming to reimburse Ascension similarly to its peers while attempting to mitigate unsustainable healthcare cost increases.
This is an evolving situation and will be updated as new information becomes available.
