Wellmont, UnitedHealthcare extend negotiations on new deal

Nathan Baker • May 31, 2014 at 9:35 AM

Wellmont Health System and UnitedHealthcare now have three more weeks to publicly shame one another into reaching a deal for medical reimbursements, while tens of thousands of people in the region wait to find out if they will have to pay out-of-network costs in hospitals where they previously received in-network care.

Late Friday afternoon, a day before the May 31 expiration of a contract extension agreement signed earlier in the year, both parties agreed to another extension, pushing the drop-dead date for current patients and customers on United’s Medicare Advantage, Commercial and Dual Complete plans to June 18.

“In an agreement reached between both organizations Friday, the contract between Wellmont and UnitedHealthcare has been extended to June 18,” an emailed statement from Wellmont spokesman Jim Wozniak said. “UnitedHealthcare has also agreed to Wellmont’s request to engage in a series of intensive in-person negotiations prior to that date in an effort to reach a contract agreement.”

Negotiations between the two have not been the most amicable publicly, as each have attempted to goad the other into inking an agreement this month.

The health insurer fired the first public shot with an email sent May 7 from United Associate Director of Communications Sarah Bearce to members of the media, accusing Wellmont of wanting to “pocket higher pay without showing that they’re delivering better results for their patients.”

United’s Regional Vice President Charles Russo said then that Wellmont’s representatives were attempting to sidestep value-based reimbursement, through which the insurer would pay a certain rate for basic coverage and then increase payments to hospitals and physicians if previously set quality and performance measures were met.

Alice Pope, Wellmont’s executive vice president and chief financial officer, countered the same day, saying the rates offered by the insurance provider were unsustainably low, and would not cover the system’s own expenses.

“United uses their power to influence the market, and we’re not going to accept it anymore, because we can’t accept it anymore,” she said.

As the deadline approached, Pope sent a mass mailing to UnitedHealthcare members, urging they switch to a competing health insurance provider, if possible.

“Wellmont’s hospitals, outpatient surgery centers, imaging centers, other facilities, physicians and physician practices, including Wellmont Medical Associates and the Wellmont CVA Heart Institute, will not accept UnitedHealthcare insurance as of May 31, 2014,” a post on the system’s website said May 30. “This means if you continue to use Wellmont facilities and practices after this date, there will be additional costs to you.”

A letter dated May 28 from United’s Chief Legal Officer Thad Johnson, called the claims in Pope’s letter “false, misleading and inflammatory,” and said the system’s offer to help current patients understand coverage options from other providers crossed the line into marketing material, which should have been approved by the Centers for Medicare and Medicaid Services and coordinated through United.

“We reserve all rights to take whatever actions are necessary to preserve our business relationships with our members and customers, including seeking court intervention,” Johnson’s notice said.

The announcement Friday of the contract extension could be sign that the two entities are willing to work together, although a statement in the email attributed to Pope indicates a remaining impasse.

“It would not be appropriate financial stewardship to accept the proposal as currently offered,” Pope said. “We are hopeful with this contract extension and further negotiations, we might be able to achieve an equitable resolution that effectively meets the needs of our patients and UnitedHealthcare’s members.”

Last year, the two parties were involved in a similar dispute over Medicare Advantage plan coverage that ultimately ended in a renewed agreement.

Follow Nathan Baker on Twitter @JCPressBaker. Like him on Facebook at www.facebook.com/jcpressbaker.

Recommended for You

    Johnson City Press Videos