Recently UnitedHealthcare of North Carolina received notice that several hospitals affiliated with Duke LifePoint were up for contract renewal and may lose their in-network status. This can be an alarming and confusing time for covered members who use these facilities as they would now be considered out-of-network under UnitedHealthcare.
Out-of-network benefits generally pay significantly less than in-network benefits, which can leave members on the hook for much larger out of pocket expenses. Often, these contract negotiations get resolved at the eleventh hour and the facilities never actually lose their in-network status. Sometimes, however, these contract negotiations can continue on beyond the expiration of the previous contract, which leaves the facility out-of-network until a resolution can be found.
Members can become an unfortunate pawn in these negotiations. Many times we see insurance carriers and facilities use scare tactics to encourage members to contact with the other party and encourage them to accept whatever offer has been put on the table. Likewise, one party will deliberately allow the deadline to pass in order to create disruption for members, which encourages the other party to quickly come to an agreement.
Regardless of how these contract negotiations proceed, it’s important to ensure that you are communicating with your employees so that they understand how their out-of-pocket expenses may be impacted. It is often the case that once these negotiations are complete, the network status will revert back to the original contract’s ending date. This can result in claims being reprocessed and confusion at the member level. There will likely be several more of these kinds of disruptions in 2019.
Keeping our customers up to date on these kinds of changes is our number #1 priority. If you’d like more information on how we can help you stay up to date on carrier changes or how we can develop a comprehensive communication strategy for your employees, contact us.