8 ongoing payer-provider contract disputes

As payers and health systems ink new in-network contracts nationwide, these are eight ongoing disputes Becker's has been tracking:

  • BCBS Tennessee and Memphis-based Methodist Le Bonheur Healthcare will be out of network by Dec. 31 without a new contract, though negotiations are ongoing, the Memphis Commercial Appeal reported Nov. 25. 

  • Regence BlueShield Washington and two providers, The Polyclinic and The Everett Clinic (both owned by Optum), will be out of network by Dec. 19 after Optum requested a 14.75 percent rate increase, the Herald Net reported Nov. 23.

  • UnitedHealthcare and Albuquerque, N.M.-based Lovelace Health System have stalled in their contract negotiations for 2023. Some Lovelace facilities will be out of network with some plans by Jan. 1, and Lovelace physicians will go out of network for all plans on March 1 without a new contract.

  • Cigna's Medicare Advantage plans will go out of network with Cameron (Mo.) Regional Medical Center on Dec. 31 without a new contract.

  • CDPHP and Albany, N.Y.-based St. Peter's Health Partners will be out of network if an agreement is not reached by Dec. 31, though both sides have said they are optimistic about reaching a deal.

  • UnitedHealthcare and Syracuse, N.Y.-based SUNY Upstate University Hospital will be out of network if the two sides are unable to reach a new contract before Dec. 31. The dispute could leave 20,000 patients out of network with the hospital. 

  • BCBS Mississippi and Jackson-based University of Mississippi Medical Center remain without a contract after the organizations went out of network with each other in April, leaving 750,000 people without access. Several weeks without progress led the state's insurance commissioner to suspend mediations indefinitely Oct. 11.  

  • BCBS Illinois and Springfield Clinic have been out of network with each other since November 2021. BCBS says 55,000 patients are affected. 



Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast

Top 40 articles from the past 6 months