Several major health systems are struggling to reach contract agreements with UnitedHealthcare (UHC) to provide care services for members covered by the insurer. Recently, Duke Health posted in a blog that its UHC reimbursement is below the 25th percentile among similar hospitals in North Carolina, which it calls “unacceptable” as it continues contracting talks with UHC. If no agreement is achieved, Duke will be out-of-network as of November 1 for several health plan products, including employer-based plans. Huntsville Hospital System in Alabama last week announced it is terminating its contract with UHC, and University of Florida Health ended its contract with the insurer as of September 1. Meanwhile, last month, HCA Healthcare and UHC reached an agreement just hours before their contracts were scheduled to expire. Beyond reimbursement, several systems are also aggravated over the rates of claim denials from UHC, which they say happen 40% more often with UHC than with other payers, according to Becker’s. Duke also notes that UHC is 57% slower to pay claims as well.
Giant footprint: UHC is the largest payer in the country, but it’s also the owner of Optum, which houses primary care and urgent care operations. Optum is the country’s largest employer of physicians with a total physician force in the neighborhood of 90,000. In recent months, Optum has shuttered its virtual care offerings and announced the closure of clinics in several states. All of this plays out against the backdrop of UHC’s massive clean-up operation after the Change Healthcare cyberattack that occurred in February and paralyzed claims administration and payment processing across the entire U.S. healthcare ecosystem.