Envision, UnitedHealthcare break ties: 5 things to know

Nashville, Tenn.-based Envision Healthcare is no longer in UnitedHealthcare's provider network after the organizations couldn't agree on reimbursement rates.

Five things to know: 

1. The change took effect Jan. 1. In an email to Becker's Hospital Review, UnitedHealthcare said the change will affect physician groups in 44 states and the District of Columbia. Most of the physicians affected provide emergency room and anesthesiology services. Some Envision physicians also provide radiology, neonatology, hospitalist, primary care and specialty care services.

2. Envision said in a Dec. 31 news release that UnitedHealthcare made the decision to cut ties. Envision stated that UnitedHealthcare is cutting physician reimbursement rates.

3. According to Envision, UnitedHealthcare has characterized reimbursement rates for Envision physicians as three times higher than their median rate. The physician staffing firm claimed if this was the case, "United has cut reimbursement rates for emergency room doctors [across] the country by 50 percent." 

4. UnitedHealthcare framed the network change differently. A spokesperson for the health insurer said Envision is "driving up the cost of care for the people and customers we serve. Envision expects to be paid nearly double the median rate we pay other anesthesiologists and more than triple the median rate we pay other ER physicians." UnitedHealthcare provided one example in Florida, where it says 90 minutes of anesthesia services for knee surgery would cost more than twice as much if an Envision physician administered it compared to an anesthesiologist reimbursed at a median rate.  

5. The organizations have clashed in the past. In December 2018, UnitedHealthcare and Envision agreed to extend their contract for 2019 despite legal battles over arbitration and disagreements about surprise billing.

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