Consolidation increasing stakes for payer-provider contract disputes, study finds

As more providers and insurers consolidate, the chances that both sides will run into disagreements over their in-network contracts have heightened, according to a report from the Center on Health Insurance Reforms from the Georgetown University Health Policy Institute in Washington, D.C. 

For the report, researchers reviewed insurance laws across six states, based on geographic diversity and recent high-profile payer-provider conflicts that took place there: California, Georgia, Massachusetts, North Carolina, Pennsylvania and Texas. Some high-profile conflicts in the states include UnitedHealthcare and Houston Methodist; Pittsburgh-based Highmark Health and UPMC; Cigna and San Francisco-based Dignity Health; Cigna and Asheville, N.C.-based Mission Hospital; and Cigna and Irving, Texas-based Christus Health.

In interviews with regulators and insurers, researchers found both agreed that the more providers and payers consolidate, the higher the stakes for contract disputes. This will expose more consumers to care disruptions and higher out-of-pocket costs, they said. Several regulators warned that a greater number of high-profile contract disputes will take place in the future. 

State officials and insurers offered several recommendations for improving the patient experience through contract disputes, including providing members with advanced notice of possible contract termination and requiring insurers to hold their enrollees harmless if they can't access necessary care elsewhere.  

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