5 recent contract disputes, resolutions involving payers

From a judge ordering Northside and Anthem to take their dispute to the Georgia Department of Insurance to Humana and Louisiana's Baton Rouge General Hospital reaching a coverage agreement, here are five recent payer contract disputes and resolutions:

1. The 400,000 patients at Atlanta-based Northside Hospital System with Anthem insurance will remain in network "until further order," a judge ruled April 13. The judge extended the contract while determining the sides must take their dispute before the Georgia Department of Insurance. The dispute began in 2021, when Anthem notified Northside it wanted to change its contract, alleging Northside charged more than most hospitals in the area.

2. At least 54,000 people face the loss of in-network coverage at the Medical University of South Carolina if a contract dispute with UnitedHealthcare is not resolved before Sept. 14. Charleston-based MUSC first notified patients with UnitedHealthcare plans about the potential coverage loss in November. A MUSC spokesperson told the Post and Courier the provider is in discussion with UnitedHealthcare and hopes to reach an amicable conclusion to the negotiations. 

3. Portland-based MaineHealth's flagship hospital will exit the Anthem insurance network in January, citing more than $70 million in unpaid claims over the past three years as justification for the split. The 637-bed Maine Medical Center in Portland is MaineHealth's largest hospital and Anthem is the most dominant health insurer in the state, with 69 percent market share. Maine Gov. Janet Mills said in an April 6 statement that she is deeply concerned about the potential contract termination and that it should be avoided at all costs. 

4. Humana and Louisiana's Baton Rouge General Hospital in late March reached a coverage agreement for up to 12,000 Medicare Advantage members. Earlier that month, the hospital sent a May 3 contract termination notice to Humana in a dispute over reimbursement rates. The hospital said it had not received a rate increase from Humana in more than a decade. 

5. The University of Vermont Health Network agreed to terms with UnitedHealthcare in late March, days before their contract was set to expire. The agreement extends through March 31, 2023, and affects about 2,900 UnitedHealthcare members in Vermont and northern New York. The agreement comes after UVM expressed its intent to end its contract with UnitedHealthcare over administrative and operational hurdles.

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