State officials seek to resolve disputes threatening health coverage for 1,800 Vermonters - freetxp

State officials seek to resolve disputes threatening health coverage for 1,800 Vermonters

The University of Vermont Medical Center in Burlington on Monday, November 23, 2020. Photo by Glenn Russell/VTDigger

The Green Mountain Care Board has been urging the University of Vermont Health Network to work out a solution to a contract dispute with UnitedHealthcare that could leave more than 1,800 Vermonters unable to access health care at UVM and its affiliated providers.

“We are very concerned about this issue and we strongly urge the two parties to come together and reach an agreement because Vermonters should not be the ones who lose here,” said Susan Barrett, executive director of the Green Mountain Care Board.

The state board reviews and approves hospital budgets and some health insurance plans, but it is powerless to make the state’s largest health provider and the country’s largest health insurer reach a deal that would keep some 2,900 — including 1,814 Vermonters and about a thousand residents of New York — covered after April 1.

That is the date when an existing contract between the two organizations expires. UnitedHealthcare has written to patients to inform them that it will no longer cover their health care at UVM Health Network as an in-network provider after that date if the two sides cannot reach agreement.

The decision affects patients on employer and individual plans. Medicare Advantage, Medicare supplemental insurance and veterans in Vermont would not be affected, UnitedHealthcare told VTDigger last week.

Cole Manbeck, a spokesperson for UnitedHealthcare, cited UVM’s request for a rate increase of nearly 10% for fiscal year 2022 as the reason it is letting its contract with the health network expire.

Manbeck said UVM Medical Center charges the insurer’s employer-sponsored plans 17 times what it charges Medicare for a CT scan and 13 times for an MRI.

Meanwhile, Manbeck said, the cost of care at another in-network academic medical center it declined to name in a bordering state is approximately 20 percent lower than at UVM Medical Center.

The insurer has been adding other Vermont health care providers to its preferred network. Last fall, it asked Green Mountain Surgery Center if it wanted to be included as a preferred provider, according to the center’s CEO, Amy Cooper.

Some 1,440 Vermonters are in Administrative Services Only, or ASO, health plans administered by UnitedHealthcare, according to Vermont Financial Regulation Commissioner Mike Pieciak.

In ASO plans, employers self-insure but hire an insurance company to administer the plan and to offer stopgap coverage. That means that the employer covers up to a certain amount of expenses for all of its employees, and then is insured if health care costs go above that. These plans are federally regulated through employers regulated under the Employee Retirement Income Security Act, or ERISA, and the Centers for Medicare and Medicaid Services, Pieciak said.

Six Vermont employers account for those 1,440 employees, Pieciak said. Most employees live around Burlington and therefore require care through the UVM Health Network.

Another 374 Vermonters are insured by UnitedHealthcare under coverage offered by out-of-state employers.

“We are communicating with the parties,” Pieciak said. “We are encouraging them to find resolution in terms of the contractual negotiations.”

Pieciak said he is urging the UVM Health Network and UnitedHealthcare to at least extend their contract beyond April 1 in order to allow insured employers and employees time to find new health insurance. Given that these are either federal plans or plans contracted for in other states, Vermont does not have any regulatory authority, he said.

In a statement, UVM Health Network said it has not been contacted by UnitedHealthcare and that the insurer’s policies have for years “made it difficult for our patients to receive the care they need, for the sole benefit of United’s stockholders.”

“Despite our best attempts over many months, UnitedHealthcare disengaged in negotiations with us several weeks ago,” UVM said in the statement. “We hope that they will join us in putting patient needs above their profits and present us with a proposal that both provides the payment rates we need to continue providing patient care, and changes the (policies) that have harmed their members.

“We are deeply sorry for any stress or inconvenience this has caused to our patients.”

The insurer said it delivered a proposal to UVM Health Network at least two weeks ago.

“They have rejected our proposal that included meaningful rate increases and have never provided a counterproposal,” Manbeck said, adding that the insurer is working with UVM Health Network to arrange a meeting later this week.

A hospital network in New Jersey ended contracts with UnitedHealthcare last year over a dispute about reimbursements.

Eliza Graves at home in Jericho on Friday, March 4, 2022. Photo by Glenn Russell/VTDigger

Among the Vermont patients caught in the conflict is Eliza Graves of Jericho, who was set to begin chemotherapy at UVM Medical Center Tuesday for a rare and aggressive form of cancer, but whose care has been complicated by the contract dispute.

Graves said she has not heard back from UVM Health Network. She said UnitedHealthcare discussed gap coverage options with her, but she said the insurer was offering two months of coverage at most.

New Hampshire-based Dartmouth-Hitchcock Health is a preferred provider with UnitedHealthcare, so Graves and her husband drove some 90 minutes to its flagship medical center in Lebanon, New Hampshire, on Tuesday to meet with an oncologist, she said.

Graves and her husband were planning to drive to Lebanon again Wednesday for a CT scan so she could begin chemotherapy there next week.

“I just can’t afford to have an interruption in chemo at UVM, and since it’s been seven weeks now since discovery (of her tumors), I am desperate to start treatment,” Graves said. I just can’t wait until April to see where I end up. I am holding out hope that United and UVMMC can come to an agreement and maybe I can switch back to UVM in between chemo cycles, but for now, I need stability and a reliable location, even if it’s far away.”

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