Minnetonka, Minn.-based UnitedHealth Group notified 300 hospital systems it will treat hospital services performed by Nashville, Tenn.-based Envision Healthcare (AmSurg) as out-of-network claims beginning Jan. 1, 2019, WHBL reports.
Here are five insights:
1. The health insurer mailed letters to 300 hospitals about the impending network switch Sept. 21. In the letters, UnitedHealth claims Envision wants to set payment rates at nearly 600 percent of the Medicare reimbursement rate for seniors and disabled patients, and two times the average payment rate for emergency room physicians.
2. Envision spokeswoman Kim Warth told WHBL UnitedHealth's letters are misleading because they only include data for a single group in one market. UnitedHealth is making "egregious demands" for price cuts "that will force all of [Envision's] physicians out of network," Ms. Warth said in a written statement to WHBL.
3. UnitedHealth Group and Envision Healthcare failed to reach a new contract agreement after months of negotiations.
4. In March, Envision sued UnitedHealth over allegations the payer violated a contract by refusing to add Envision physicians to its network and lowering negotiated payment rates. In response, UnitedHealth criticized Envision's billing practices and announced it would terminate their contract.
A court-ordered arbitration between the companies is ongoing.
5. Envision agreed to be bought by KKR in a $5.5 billion transaction expected to close in the fourth quarter.