Allentown, Pa.-based Lehigh Valley Health Network, part of Jefferson Health, will exit UnitedHealthcare’s Medicare Advantage network Jan. 26, following a contract dispute between the two organizations.
Five things to know:
1. After months of negotiations, LVHN said UnitedHealthcare has not engaged fairly and failed to honor previously agreed-upon rates. UnitedHealthcare said LVHN issued notice to end the contract and is demanding a price hike of more than 20% in a single year. Both organizations shared updates Jan. 21.
2. UnitedHealthcare said it remains in active negotiations with LVHN to maintain network access for members enrolled in employer-sponsored commercial plans and the Veterans Affairs Community Care Network. If no agreement is reached, most LVHN providers and facilities would also go out of network for those plans starting April 26. A small number of LVHN providers that participate in Medicaid and CHIP could also be affected at varying dates, according to UnitedHealthcare.
3. LVHN said patients with Medicare Advantage coverage will no longer be able to access its services at in-network rates starting Jan. 26. Patients may still seek care out of network if their plan includes such benefits, or by paying out of pocket.
4. Jefferson Health noted that emergency care at LVHN facilities will remain in network regardless of insurance status, and some patients may qualify for continuity of care programs that allow them to maintain access to their current clinicians.
5. LVHN and Jefferson Health merged in 2024 to form a 32-hospital system with more than 700 care sites and over 65,000 employees.
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