Valley News - UnitedHealthcare, UVM Health Network could dispute 2,900 patients searching for care - freetxp

Valley News – UnitedHealthcare, UVM Health Network could dispute 2,900 patients searching for care

Some 2,900 patients covered by UnitedHealthcare may no longer be able to see providers at the University of Vermont Medical Center and its connected hospitals, as the nation’s largest insurer and Vermont’s largest health network have been unable to reach a contract.

If the stalemate continues, of patients would be sent scrambling providers in a region with find few options, hundreds of specialists — and in some cases no nearby alternatives for the alternatives they require.

Among them is Eliza Graves, 34, of Jericho, Vt., who is about to begin chemotherapy at UVM Medical Center for a rare and aggressive form of cancer. Now, she said, she’s worried about starting treatment because she said UnitedHealthcare told her it would cover only about 30 days of chemotherapy.

“It’s life or death for me,” Graves said. “It’s criminal. It feels like a hostage situation, and they certainly don’t seem to care at all about the people that they’re affecting.”

A Feb. 23 letter distributed by UnitedHealthcare to its clients warning them that coverage at the University of Vermont Health Network may be ending for patients on employer and individual plans as of April 1.

“We’re working hard to extend their participation to keep them in-network for our Employer and Individual health care plans,” the letter said.

Medicare Advantage, Medicare supplemental insurance and veterans in Vermont would not be affected, UnitedHealthcare said.

UVM said it would continue to accept UnitedHealthcare insurance for home health and hospice patients.

The Feb. 23 letter tells clients that if UnitedHealthcare cannot reach a deal with University of Vermont Health Network, then patients would lose their coverage at University of Vermont Medical Center, Central Vermont Medical Center in Berlin, Porter Medical Center in Middlebury, and three hospitals in New York : Alice Hyde Medical Center, Champlain Valley Physicians Hospital Medical Center and Elizabethtown Community Hospital.

And if patients seek care outside of the UnitedHealthcare network, it warns, their costs will increase or they may have to pay the full cost of medical care.

The letter recommends clients switch their care to Copley Hospital in Morrisville, Gifford Medical Center in Randolph or Northwestern Medical Center in St. Albans, or one of two New York hospitals: Adirondack Medical Center or Canton Potsdam Hospital.

The letter reassures clients that they can still get emergency care at any hospital.

The insurer tells clients they may be able to continue care at University of Vermont Medical Center and affiliated hospitals for a short time if they are pregnant, actively getting treatment for an illness or receiving treatment such as chemotherapy.

Most of the 2,900 patients that UnitedHealthcare estimates would be affected live in Vermont, with some in New York. It could not provide exact figures.

UnitedHealthcare cited high costs at UVM — which it attributes to UVM’s market dominance — for its decision to let its contract with UVM expire. UnitedHealthcare said UVM is seeking a rate increase of nearly 10% for fiscal year 2022. The insurer said the cost of care at UVM for its members in employer and individual plans has increased by 15% since 2020.

“The rapid acceleration of costs at the University of Vermont Health Network is not affordable or sustainable for the residents and employers of Vermont and northern New York,” UnitedHealthcare said in a statement.

“Our top priority is to renew our relationship with the health system so that our members have continued access to quality care that is affordable. We hope the University of Vermont (Health Network) shares that same commitment and will work with us to ensure the people and employers we mutually serve have continued access to health care without disruption,” it said.

UVM Health Network officials — who said it was their decision not to renew the contract — blame the rising costs on increasing staffing, supply and pharmaceutical costs.

“Our Network continues to be one of the lowest-cost in the nation, but we have to cover our costs to provide timely access to quality care,” the health network said in a statement.

The health network also criticized administrative hurdles at UnitedHealthcare.

“For a number of years, our ability to provide timely and appropriate care to patients covered by UnitedHealthcare Commercial insurance, a national, for-profit insurance company, has been hindered by their administrative and operational requirements,” officials said in the statement.

“Despite our best efforts to resolve these issues, patients continue to experience unnecessary delays in and restrictions on approvals for common tests, imaging treatments and medications, among other challenges, due to United’s own policies and reimbursement practices,” according to the statement.

As an example, UVM said a policy that kicked in last fall prevented the medical center and its affiliates from scheduling colonoscopies for UnitedHealthcare patients.

UnitedHealthcare is a subsidiary of Minnesota-based UnitedHealth Group Inc., an integrated health care company that also includes Optum Health, a large nationwide network of health providers; OptumRx, a large pharmacy benefit manager; and OptumInsight, a health care technology business. UnitedHealth Group’s 2021 revenues were $288 billion.

‘I’m absolutely devastated’

Graves, the Jericho resident, was recently diagnosed with angiosarcoma of the pancreas, one of the rarest cancers. She said five tumors surround her pancreas.

“I am just starting my treatments for it in the hopes of doing anything to prolong my life,” Graves said. “It’s a highly aggressive, just terrible cancer.”

Most of Graves’ doctors are at UVM Medical Center.

“I’m absolutely devastated,” Graves said. “This significantly affects me.”

She moved back to Vermont two years ago to be near her mother, who has early onset Alzheimer’s disease, and it took her a long time, she said, to be able to see all the doctors she needed to see for her complex medical case, even prior to being diagnosed with cancer. She has asthma and Ehlers-Danlos syndrome, a hereditary disorder of connective tissues that makes it so that her joints dislocate easily.

“With COVID, there are so many delays. It’s so challenging to get anywhere with a doctor,” Graves said. “The only available doctors are at UVM, and they all have huge waiting lists.”

She reinjured an ankle in July and had to wait until January to be scheduled for surgery that led to the discovery of her cancer. Because of her asthma and her Ehlers-Danlos, she said, her pulmonologist and her allergist recommended a CT scan of her lungs prior to surgery to make sure that she would not have any problems with anesthesia. That’s when the mass on her pancreas was discovered.

After several delays, she was officially diagnosed Feb. 17, she said. Her cancer is so rare that UVM referred her to Dana Farber Cancer Institute in Boston, where doctors are directing her care and are covered by United Healthcare. Her Dana Farber oncology team recommended she undergoes chemotherapy as close as possible to home, at UVM.

“Dana Farber has been excellent, and they are astounded that this is going on,” Graves said.

Her first oncology appointment is supposed to be at UVM Medical Center on Tuesday, but to stay covered by UnitedHealthcare, she now has to go to Dartmouth-Hitchcock Medical Center in Lebanon 95 miles away.

“I don’t want to be driving an hour-and-a-half each way with a busted ankle while I’m on sick chemo as a dog,” Graves said. “I just don’t understand how it can be allowed and how everyone’s OK with it and how UVM can consider themselves pillars of the community and not care a lick that so many of us have no other options. It’s not like there are other hospitals close by that are equal to UVM, not at all.”

She cannot switch insurance plans because her husband’s job offers only UnitedHealthcare and Kaiser Permanente, which does not cover providers in Vermont.

“I’m terrified,” Graves said. “I’m so desperate to start treatment.”

She said she does not know if she should keep her Tuesday appointment at UVM because she cannot afford to go somewhere out of network for chemotherapy.

“I can’t waste time trying to transition in the midst of it and miss out on vital chemo when this is much growing every week,” Graves said. “I’m set out to dry, and I can’t believe it.”

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