Health insurance giant now says 5,000 Vermonters' coverage at risk in contract dispute

Health insurance giant now says 5,000 Vermonters’ coverage at risk in contract dispute

The University of Vermont Medical Center in Burlington. File photo by Glenn Russell/VTDigger

Far more Vermonters than initially believed are at risk of losing services offered by the University of Vermont Health Network if the state’s largest health care provider fails to reach an agreement with UnitedHealthcare, the nation’s largest insurer, by Friday.

State officials previously estimated, based on information provided by UnitedHealthcare, that 1,800 Vermonters were at risk. But Michael Pieciak, commissioner of the state Department of Financial Regulation, told VTDigger Monday that UnitedHealthcare has since clarified that’s the number of Vermonters who have sought medical care in the past year at UVM Health Network. UnitedHealthcare actually covers 5,000 Vermonters who receive care from UVM’s providers, he said.

Only Vermonters insured under UnitedHealthcare’s employer-provided plans are affected by the insurer’s dispute with UVM Health Network. The fight does not include Medicare supplemental plans or any veterans’ health insurance plans.

Vermont officials said Monday they were hopeful that the two sides were close to an agreement.

“I’m very optimistic that this is going to be settled within 48 hours,” Kevin Mullin, chair of the regulatory Green Mountain Care Board, told VTDigger.

Mullin said he wrote to both sides earlier this month urging them to reach an agreement.

The Green Mountain Care Board has jurisdiction over the health care plans offered on the state exchange, Vermont Health Connect, and has oversight of hospital budgets and the fees they charge, but it does not have any jurisdiction over UnitedHealthcare employer-provided plans, which are federally regulated.

Pieciak said Monday he was “optimistic that this will get resolved.”

UnitedHealthcare wrote to at least some patients last month that it would stop considering UVM Health Network as an in-network provider as of April 1 because the two organizations could not agree on the fees the insurer would reimburse the health network.

Leah Lotto, a Burlington resident, said she did not get that letter before finding out about the changes when a representative of UVM Health Network told her on the phone recently that her care would no longer be covered after Thursday.

Lotto had just finished a session of radiation treatment for cancer when she spoke to VTDigger on Monday. The treatments were supposed to last four more weeks.

“I have a whole bunch of other cancer-related treatments scheduled and planned,” Lotto said. “And I don’t know if those are going to be covered.”

Lotto’s 5-year-old child is also covered under her insurance plan.

“My understanding is we can’t even try to get continuing care for him,” Lotto said. “So we need to figure out something else for him.”

Under the federal No Surprises Act, health insurers must provide certain types of coverage that a patient has already started receiving — known as continuing care — for 90 days after a contract with a health care provider ends.

Pieciak said he has been in touch with UnitedHealthcare to find out what the insurer would be willing to do for patients beyond its 90-day obligation. He said the company is open to making coverage plans with patients who reach out to it.

Pieciak said his office has heard from patients who are afraid of losing doctors and other providers they’ve seen for years — and sometimes decades. He’s also heard from employers who say it is hard to recruit employees if health insurance does not include the largest health care provider in the state.

Vermont’s chief health care advocate, Mike Fisher, told VTDigger his office has received calls from many Vermonters “who are really harmed by this” and who fear losing relationships with their providers.

Mullin said UnitedHealthcare should have notified employers much earlier that it would no longer cover UVM Health Network within its network.

“Vermonters are being caught as pawns between two giant health care providers,” Mullin said.

UnitedHealthcare did not respond to a request for comment on Monday about its negotiations with UVM Health Network. A spokesperson for the health network declined to comment on the talks.

Lotto said her understanding is that the 90-day provision under federal law would cover only her radiation treatments.

She said she was frustrated not only by her possible loss of coverage, but by the way she learned about it in mid-March. She was trying to schedule a physical therapy appointment for the following month, she said, but was told that she couldn’t because her insurance would no longer cover it. When she asked if this was only for physical therapy, she was told: “No. All of UVM isn’t going to take UnitedHealthcare anymore.”

Lotto said she had that conversation with UVM Health Network on the afternoon of March 18 — just days before her radiation treatments were set to begin.

“Very weird and terrible news to get and it seemed like it couldn’t possibly be true,” Lotto said.

She said she has not heard from UnitedHealthcare whether they would cover her treatments beyond Thursday.

“Could you tell me right now that I’m not going to have to pay for this treatment that I need to start?” she said she asked a UnitedHealthcare representative. “And they wouldn’t tell me.”

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Filed under:

Health Care

Tags: Department of Financial Regulation, Green Mountain Care Board, health care, Kevin Mullin, Michael Pieciak, Mike Fisher, UnitedHealthCare, University of Vermont Health Network, University of Vermont Medical Center, UVM Health Network

Fred Thys

About Fred

Fred Thys covers business and the economy for VTDigger. He is originally from Bethesda, Maryland, and graduated from Williams College with a degree in political science. He is the recipient of the Radio, Television, and Digital News Association’s Edward R. Murrow Award for Investigative Reporting and for Enterprise Reporting. Fred has worked at The Journal of Commerce, ABC News, CBS News, CNN, NBC News, and WBUR, and has written for Le Matin, The Dallas Morning News, and The American Homefront Project.