Baltimore-based Johns Hopkins Medicine and UnitedHealthcare are at odds over prior authorization requirements as they negotiate a new contract, The Baltimore Sun reported July 29.
The sides have been negotiating a new contract for seven months and their current agreement has been extended five times during that span, according to the report. The contract is currently set to expire Aug 25.
While they’ve agreed to medical care reimbursement rates, they’ve fought over prior authorization requirements and treatment denials, according to the report.
“Unfortunately, UnitedHealthcare has chosen to slow down negotiations recently because we refused to accept their harmful practices that hurt patients: aggressive claim denials that delay necessary care, excessive red tape that forces patients to wait for treatments, and significant payment delays that strain our ability to provide care,” a Johns Hopkins spokesperson told the Sun.
UnitedHealthcare has said Johns Hopkins is “demanding language in its contract that would give them the right to refuse treatment for any employer it does not want to do business with.”
“They are attempting to reserve the right to turn away UnitedHealthcare members at their discretion as an in-network provider,” the payer said.
The parties are continuing to negotiate ahead of the Aug. 25 deadline.
A split would affect those with employer-sponsored commercial plans, individual family plans, Medicare Advantage plans — including Dual Special Needs Plans and group retiree — and Medicaid plans. Johns Hopkins physicians would also be out of network for people enrolled in employer-sponsored commercial plans. The system’s physicians do not currently participate in UnitedHealthcare’s Medicare Advantage or Medicaid networks.
The negotiation affects Johns Hopkins providers in Maryland, Virginia and Washington, D.C. Johns Hopkins providers in Florida will remain in network, regardless of the outcome.
