Here are six payer-provider contracting disputes and settlements that have occurred since Jan. 1:
1. BlueCross BlueShield of Texas and Houston-based Memorial Hermann said March 11 that they reached a new agreement to keep 100,000 members in-network. The two parties initially severed their contract March 1, after failing to reach an agreement. The parties had been negotiating since November 2021, when Memorial Hermann notified the payer of its intent to end the contract.
2. University of Vermont Medicine Health Network in Burlington has expressed its intent to end its contract with UnitedHealthcare over administrative and operational hurdles. The contract expiration would leave 2,900 patients at UVM and its affiliates without coverage after April 1. The Green Mountain Care Board has urged the health network to continue negotiations with the insurer.
3. Fort Lauderdale, Fla.-based Broward Health plans to end its contract with UnitedHealthcare April 1 if its demands for a new agreement are not met. The health system said it has been working with UnitedHealthcare "for months" to reach a new contract, but the two parties are now at an impasse. Broward Health said it is asking UnitedHealthcare to reimburse its providers at levels comparable to what it pays other facilities in South Florida or at levels comparable to what other health plans pay it. UnitedHealthcare said Broward Health is asking for an "egregious" price hike.
4. University of Mississippi Medical Center in Jackson notified patients that it is nearing a contract deadline with Blue Cross and Blue Shield of Mississippi. The state's largest provider and payer must agree on a new contract by March 31 or patients covered by Blue Cross and Blue Shield of Mississippi will be out of network.
5. Anthem must extend its contract with Atlanta-based Northside Hospital System through April 15, a court ruled in late January. Anthem began negotiations with Northside Hospital System in December 2021, and the initial deadline to renew the contract was the end of 2021. After no agreement was reached, a judge ordered Anthem to keep 400,000 patients in-network through Feb. 1. On Jan. 31, the contract was further extended by the court after the parties failed to reach an agreement.
6. Rochester, Minn.-based Mayo Clinic is no longer allowing some Medicare Advantage beneficiaries to schedule appointments. The provider initially began to limit appointments during the winter months because of capacity concerns, but has now turned to "a change in enforcement" that blocks out-of-network patients from making appointments to ensure those in contracted plans have access to Mayo Clinic facilities.