LVHN and UnitedHealthcare Negotiations Nearing Deadline
Lehigh Valley Health Network (LVHN) and UnitedHealthcare are under pressure to resolve their disputes. LVHN had previously announced that it could terminate its contract with UnitedHealthcare this month unless both parties come to an agreement.
As of January 26, Medicare Advantage patients insured by UnitedHealthcare will lose access to in-network services from LVHN providers, a significant change as the deadline approaches.
69 News reached out to both organizations for updates on the negotiations. While spokespeople declined to provide direct comments, they did exchange information via email. It seems the deadlock continues, as little progress has been reported since the situation was first disclosed.
LVHN, which is part of Jefferson Health, claims that UnitedHealthcare slashed reimbursements by nearly 40% starting in 2021 without any prior agreement. However, UnitedHealthcare firmly disputes this assertion, stating, “UnitedHealthcare will continue to reimburse LVHN for the contract fees agreed to by both organizations,” according to an email from a representative.
UnitedHealthcare argues that the real issue lies in LVHN demanding a 20% price increase for the first year of the contract. This would position LVHN hospitals as the priciest in Eastern Pennsylvania when compared to similar healthcare systems, they stated.
On the flip side, LVHN maintains that their disagreement stems from UnitedHealthcare not honoring previously established rates, not from a desire for increased prices. The network has even initiated legal actions in 2023 to compel UnitedHealthcare to comply with these agreed terms.
If the contract is indeed terminated, Medicare Advantage patients will be considered out-of-network starting January 26, with those on employer-sponsored plans facing a similar situation on April 26.
This change will only affect LVHN facilities and physicians, as UnitedHealthcare noted that it will continue to be in-network with Jefferson Health, which serves the Philadelphia metro area and its nearby counties.
According to previous reports, around 70,000 LVHN patients carry UnitedHealthcare insurance.
Both parties expressed optimism about reaching an agreement eventually. LVHN emphasized, “We stand ready to engage and are committed to finding fair solutions that protect patient access to quality care and ensure we can serve our communities effectively.”
UnitedHealthcare also indicated its willingness to negotiate, stating, “We propose rate increases that will keep LVHN compensated at market-competitive rates and will remain at the negotiating table until a solution is found.”
Additionally, UnitedHealthcare mentioned it recently finalized a contract with St. Luke’s University Health Network (SLUHN), another key health provider in the Lehigh Valley, covering Medicare Advantage plans, employer-sponsored plans, and Medicaid, including CHIP.
