UnitedHealthcare Contract Dispute

Uh oh.  A UnitedHealthcare  contract dispute with Northwest Healthcare is going to cause problems for lots of people who live on the northwest side of Tucson.

Northwest Healthcare owns Oro Valley Hospital, Northwest Medical Center, and Northwest Allied Physicians.

UnitedHealthcare provides health insurance for thousands of Medicare Advantage members in Northwest Tucson, Oro Valley, and Marana, as well as thousands of people with employer coverage.

The UnitedHealthcare contract dispute means people covered by that insurance will have to change doctors after May 1st if the contract dispute is not settled.

UnitedHealthcare contract dispute and Medicare Advantage

Northwest Healthcare is owned by Tennesee-based  Community Health Systems (CHS), a for-profit company.  The hospitals and doctors under CHS will be out-of-network for UnitedHealthcare Medicare Advantage members beginning May 1st, 2017 if the contract is not renewed.

This network problem affects members in AARP^® MedicareComplete, AARP MedicareComplete Plus HMO/POS, and DualComplete, a plan for people who qualify for Medicare and Medicaid (AHCCCS).

Members in AARP Medicare Supplement Insurance plans, insured by UnitedHealthcare Insurance Company, are not affected by this change. That’s because their primary insurance is Medicare. Their secondary insurance is the AARP Medicare Supplement.

Northwest Healthcare says United wants to lower their payments for medical care. United says Northwest Healthcare is asking for a 25% increase in payments. Because negotiations are private, we have no way of knowing which party is the greedy one.

We do know that seniors will be in a tough spot if their doctor is no longer in the network of their Medicare Advantage plan after May 1st. That’s because they cannot change their Medicare Advantage plan at this time of year (except for those in the DualComplete plan).

Affected seniors will have to find a new primary care doctor and specialists if they are part of Northwest Allied Physicians. And they will not be able to schedule surgery or procedures at Northwest Medical Center or Oro Valley Hospital.

I’ve checked my database to review my clients who are enrolled in the United Medicare Advantage plans. I make a note of their primary care provider’s name and what medical group they belong to.  I started doing this two years ago when Health Net lost its contract with Arizona Community Physicians. At least that happened during the Open Enrollment Period when people could keep their doctor and change their plan.  What a crazy time that was!

I wrote about the Medicare Advantage chaos that occurred two years ago: https://medicareblog.org/medicare-advantage-network-chaos/