Johns Hopkins providers leave UnitedHealthcare as talks stall

Doctors at Johns Hopkins Medicine hospitals and facilities have stopped taking in-network insurance from UnitedHealthcare after Hopkins and the national health insurer failed to reach a contract by a Monday deadline.

Just under 60,000 patients on UnitedHealthcare plans see Hopkins providers in Maryland, Virginia and Washington, D.C.

Hopkins said all of its providers or facilities, except for Johns Hopkins All Children’s Hospital in Florida, are considered out-of-network by UnitedHealthcare as of Monday.

“This means that UnitedHealthcare may cover less, or none, of the care patients with UnitedHealthcare insurance receive from Johns Hopkins providers or at Johns Hopkins locations,” the health system said on its website.

Hopkins is directing patients to call UnitedHealthcare for information on out-of-network care, and alerting patients that they may have to pay higher, out-of-network costs to see Hopkins providers.

Hopkins and United have been unable to agree on a contract for eight months, clashing on language over prior authorization requirements and treatment denials.

“Johns Hopkins refused to move off contractual terms no other health system in our network requires, including language that would allow it to deny patient access at its discretion,” Joseph Ochipinti, UnitedHealthcare CEO for the mid-Atlantic region, said in a statement. “Our top priority now is providing people with the care they need through continuity of care or a smooth transition to another provider, as appropriate.”

Patients in ongoing treatment for serious or complex conditions at a Johns Hopkins facility or from one of its physicians may be eligible for continuity of care, United said. That would apply to patients with conditions such as cancer or who are pregnant and who would be charged in-network rates until their treatment concludes.

Johns Hopkins hospitals and facilities are now out of network for people enrolled in employer-sponsored commercial plans, individual family plans, Medicare Advantage plans and Medicaid. Hopkins doctors are also out of network for employer-sponsored commercial plans. Its doctors did not previously participate in Medicare Advantage or Medicaid networks.

United said the contract expired after Hopkins refused an extension offer. Hopkins said it has extended the contract five times already. Each said Monday they hope to resume talks.

“The issue isn’t about how much we’re paid or small administrative issues — it’s about protecting you from practices that put United’s bottom line ahead of your well-being,” Hopkins Medicine said on its website.

That includes excessive prior authorization requirements, frequent treatment denials, administrative red tape and delayed payments, Hopkins said.

United acknowledged agreeing to the health system’s proposed rates, but a spokesman said other proposed terms would allow Hopkins to “refuse treatment for any employer it does not want to do business with. In other words, they are attempting to reserve the right to turn away UnitedHealthcare members.”

United disputes denying care, saying it approves and pays 90% of claims shortly after they’re submitted, with the rest going through additional reviews.

Frustrations over health insurance denials and medical bills made national headlines last December after the killing of UnitedHealthcare CEO Brian Thompson in Manhattan. Maryland native Luigi Mangione was indicted in April on a federal murder charge in Thompson’s killing.

Some of United’s in-network physicians and hospitals include Baltimore Washington Medical Center, Franklin Square Hospital Center, Harbor Hospital, Maryland General Hospital, Mercy Medical Center, St. Agnes Hospital, Union Memorial Hospital and University of Maryland Medical Center.

Emergency services would be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.

Have a news tip? Contact Lorraine Mirabella at [email protected] or (410) 332-6672.

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