Dispute between Johns Hopkins and UnitedHealthcare pushes patients out-of-network
An eight-month dispute between UnitedHealthcare and Johns Hopkins Medicine has led to the current contract between the insurer and health system expiring without a new agreement in place.
As of Monday, patients covered by insurance plans owned by UnitedHealth Group are no longer in-network at any Johns Hopkins location. This includes those with employer-sponsored medical benefits, coverage purchased through a government marketplace and all Medicare Advantage plans.
Patients on Medicaid plans managed by UnitedHealthcare will also be considered out-of-network if they seek care at Johns Hopkins, which could result in treatment being significantly delayed or denied.
Ironically, some employees at Johns Hopkins—including physicians—are covered by the insurer. They, too, will be considered out-of-network patients as both sides attempt to iron out sticking points.
To ease the pains of transition, some patients may be eligible for a continuity-of-care plan if they are undergoing treatment for a serious condition at Johns Hopkins. Notably, the Florida-based All Children’s Hospital—despite being part of the health system—has its own agreement with UnitedHealthcare and will remain in-network for now.
More details are available on a webpage set up by Johns Hopkins, where the health system outlines its reasons for ending its contract with UnitedHealthcare while promising to continue negotiations. Grievances include what Johns Hopkins sees as excessive prior authorization requirements, frequent denials of treatment coverage, payment delays, and administrative burdens “that take our physicians and nurses away from focusing on your treatment.”
Other key terms, such as higher payments, were agreed to by both sides. The sticking point now is how to arbitrate these types of disputes—something Johns Hopkins says it hopes to eliminate altogether.
“Johns Hopkins Medicine typically has millions of dollars in unpaid claims submitted to UnitedHealthcare—resources that should be going toward patient care,” the health system said.
“We are hopeful that United will participate in continued conversations with us so that we can reach an agreement that puts reasonable guardrails around these harmful practices,” it added.
UnitedHealth accuses Johns Hopkins of denying care
UnitedHealthcare released its own lengthy statement detailing its side of the story. The company said it is taking a stand to protect its members. According to the insurer, one of Johns Hopkins’ demands is “the right to refuse treatment for any employer it does not want to do business with.”
“In other words, the health system is attempting to reserve the right to turn away UnitedHealthcare members at its discretion as an in-network provider,” UnitedHealthcare added. It said no other provider or hospital it works with has made such demands and accused Johns Hopkins of attempting to limit patients’ access to certain healthcare services.
“Our priority is providing people with consistent, reliable and broad access to care. We expect Johns Hopkins to deliver on its commitment to provide care to the individuals and families who rely on them as an in-network provider. A provider who selectively and unilaterally turns patients away—regardless of medical need or coverage—not only undermines the foundation of what it means to be a network provider, but also erodes trust in the U.S. healthcare system by disrupting equitable access to care,” UnitedHealthcare wrote.
It also outright rejected the health system’s assertion that there has been an excessive number of denied claims. The company said around 10% of medical claims at Johns Hopkins have been reviewed, which it says is consistent with the national average.
The insurer added that it intends to continue negotiations, but as of Aug. 25, its members are out-of-network at most Johns Hopkins facilities—meaning they will need to seek care elsewhere.
The health system operates six hospitals and 50 clinics in Maryland, Virginia, Washington, D.C., and Florida. Tens of thousands of patients are expected to be impacted.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.