Because the US Congress leaves it to corporate health insurers to negotiate health care provider rates and agreements, our health care costs are far higher than they should be. In addition, access to health care is often far more difficult than it should be. In Vermont, Valley News reports that UnitedHealth’s negotiations with doctors at the University of Vermont Medical Center might fail and UnitedHealth would then cut ties with physicians for nearly 3,000 patients, forcing them to forgo care or find new physicians.
Corporate health insurers are legally obligated to think first and foremost about their own profits. The effects of their administrative, financial and other activities on patient care do not seem top of mind. So, it’s no surprise that UnitedHealth’s failure to reach agreement with physicians providing in-network care at UVM Medical Center could leave its members without a treating physician. If fewer members are getting in-network care, it would increase profits further for UnitedHealth.
UnitedHealth’s members will all have to find new network physicians if United does not reach agreement with the providers at UVM. But, that means that some members in the midst of cancer treatment could be without treatment as of April 1. Notably, people in Medicare Advantage are not affected by these negotiations, likely because the government negotiates provider rates for people with Medicare, and Medicare Advantage plans can piggyback off those rates for their Medicare members.
UnitedHealth claims UVM provider rates are rising too much. UVM, in turn, says that it is facing rising staffing and other costs and needs higher rates to survive. It adds that administrative and other operational barriers UnitedHealth imposes keeps patients from getting the care they need in a timely fashion. “Despite our best efforts to resolve these issues, patients continue to experience unnecessary delays in and restrictions on approvals for common tests, imaging, treatments and medications, among other challenges, due to United’s own policies and reimbursement practices.”
UnitedHealth told one cancer patient currently getting treatment at UVM Medical Center to get her chemotherapy from a hospital 95 miles away. Really? If Congress does not yet deem it appropriate to step in and guarantee everyone access to care, it’s hard to imagine what it will take to move policymakers.
Here’s more from Just Care:
- Prior authorization in Medicare Advantage harms patients, sometimes severely
- Avoid bad Medicare Advantage plans
- Don’t judge a Medicare Advantage plan by its stars
- Seven reasons commercial insurance cannot meet our health care needs
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
Leave a Reply