As the region’s largest locally governed, community-based non-profit health system, WellSpan is committed to keeping healthcare affordable for our patients, friends, and neighbors by routinely negotiating appropriate contracts with payors. As part of our routine contract negotiations process, WellSpan has been in discussions with UnitedHealthcare (United) for multiple months. At this time, we have not yet reached an agreement on a new contract between WellSpan and United – with the current contracts set to end on Oct. 31, 2024. Our desire is to agree on a new contract prior to the renewal date.
WellSpan is asking for a fair, middle single-digit rate overall increase for the high-quality health care services we provide, which is hardly a significant increase. United has made the broad sweeping statement that WellSpan is significantly more expensive – which is simply not true. Our costs continue to align with that of other local healthcare facilities in our market service area.
Over the last two years, WellSpan and other healthcare systems in Pennsylvania and across the nation have experienced significant inflation—18% overall—on the costs of staffing, drugs, and supplies, resulting in higher costs to deliver healthcare services to our community. We must ask for reasonable rate increases to effectively meet the ongoing healthcare needs of the community and provide exceptional care that our patients have come to expect.
In contrast, UnitedHealth Group, UnitedHealthcare’s parent company, is a for-profit, publicly traded health company that posted annual revenue of $371.6 billion in 2023 and net profit of more than $22 billion. UnitedHealthcare is an aggressive payor that creates significant administrative burdens for our physicians and care teams with undue delays and denials of care for patients which prevents timely treatment and recovery. UnitedHealthcare’s claim audits are 2.8 times higher than the average of other commercial payors. They also maintain the highest charge denial percentage of any commercial payor, preventing WellSpan from receiving timely payment for care and services for our patients.
As always, our priority includes ensuring our patients receive timely care which meets their ongoing needs. Please be assured additional conversations will occur with United between now and Oct. 31, 2024, to support continued access to WellSpan and avoid any disruption in care for affected patients. If we are unable to come to an agreement with UnitedHealthcare when the contract ends on Oct. 31, 2024, we will discontinue our participation with those insurance plans. Under state law, patients receiving ongoing care may apply for a continuation of benefits for up to 60 days after a provider stops participating with their insurance plan.
UnitedHealthcare patients with Commercial PPO insurance may choose to continue to receive care at WellSpan physician practices, imaging locations, and hospitals. Patients will be educated about potentially higher out-of-pocket costs because of WellSpan being an out-of-network as of Nov. 1, 2024. WellSpan offers flexible payment options to help with out-of-pocket costs for which patients may be responsible. UnitedHealthcare patients with Commercial HMO insurance who present to a WellSpan provider or hospital service may work with their insurance plan to find a participating provider and location to reschedule any procedures or services. Additionally, UnitedHealthcare Group Medicare Advantage members will continue to be able to see WellSpan providers for services through Dec 31, 2024.
We have provided initial notification to affected patients who received services from WellSpan in the past 18 months using UnitedHealthcare Commercial, Medicaid, or Medicare Advantage insurance plans about this potential change. At WellSpan, it is a privilege to serve our patients, and we value the opportunity to provide exceptional care for all of your health needs.
Our WellSpan Customer Service team is here to answer any questions and provide you with additional assistance. They may be contacted at (877) 631-4262 or WSHCustomerService@wellspan.org.
Frequently Asked Questions – UnitedHealthcare Commercial HMO and PPO Insurance
Q. Why has WellSpan sent letters to patients if the outcome of contract negotiations is still unknown?
A. UnitedHealthcare is required by law to send pending termination notices to both patients and providers within 30 days of a pending termination date (Nov. 1, 2024), that WellSpan would no longer be a participating provider. As a result, WellSpan opted to also communicate with these patients about the status of the negotiations and what may occur in the event WellSpan and UnitedHealthcare (United) are unable to come to reach an agreement.
Q. What UnitedHealthcare Commercial plans may be impacted by this change?
A. This includes all UnitedHealthcare Commercial plans, both HMO and PPO plans.
Q. Why haven’t WellSpan and UnitedHealthcare been able to reach an agreement?
A. As the region’s largest community-based non-profit health system, WellSpan is committed to keeping healthcare affordable for our patients and communities we serve by negotiating the appropriate contracts with payors. As part of our standard negotiation process with the insurance providers, WellSpan has been in re-negotiations with UnitedHealthcare (United), for all commercial products in advance of their contract renewal dates. Our desire is to come to an agreement with insurers before their contract renewal date.
Q. Can patients use their current UnitedHealthcare Commercial insurance until November 1, 2024?
A. Yes, any covered services received prior to November 1, 2024, will be submitted to their plan for payment.
Q. If a claim is not paid by the patients’ plan before November 1, 2024, will they be responsible for the costs?
A. Services provided before Nov. 1, 2024, will be submitted to the current insurance plan for payment. Only amounts which are not covered by the patients’ insurance carrier would need to be paid personally.
Q. Are patients able to continue to access emergency care?
A. Yes, we continue to welcome any patient needing emergency care services across our WellSpan Emergency Department locations.
Q. If patients have further concerns or questions about in network care options, who should they be referred to?
A. Patients may contact their insurance plan or employer to discuss questions and concerns about participating providers in their network.
Q. What happens if WellSpan and UnitedHealthcare are unable to come to an agreement and the contract terminates, effective Nov. 1, 2024?
A. For patients with UnitedHealthcare PPO Commercial insurance, you would still be able to see your WellSpan physician and receive care at our facilities; however, your visit would be out-of-network and you may incur higher out-of-pocket costs. WellSpan offers flexible payment options to help you pay for out-of-pocket costs for which you may be responsible.
For patients with UnitedHealthcare HMO Commercial insurance, any services scheduled after November 1, 2024, would need to be redirected. Patients should work with their insurance plan to find a participating provider and location to reschedule any procedures or services. Please check your insurance ID care to find your plan type (PPO or HMO).
Q. Will WellSpan inform me of outcome of contract discussions?
A. WellSpan will send another letter around Nov. 1, 2024, pending contract termination date, notifying patients whether we will be participating with UnitedHealthcare after October 31, 2024.
Q. Will WellSpan transfer my medical records if I have to select a new provider for services?
A. Requests for transfer of medical records can be made to the WellSpan Release of Information Department by completing the Authorization to Use or Disclose Health Information form available on wellspan.org. When on wellspan.org, enter 2606 in the search bar to locate the form – available in English, Spanish and Haitian Creole. Many components of your electronic health record are also available via our secure patient portal – MyWellSpan.
Q. Will WellSpan still be able to see me after Nov. 1, 2024, if I am in ongoing treatment?
A. Continuity of care under PA statute allows for patients to continue to be seen for ongoing treatment up to 60-days after a provider ceases to participate with a payor. Patients should be referred to their WellSpan provider involved with the patient’s care plan for application of continuity of care. Exceptions outside of this timeframe will need approval according to MAP 213.
Frequently Asked Questions – UnitedHealthcare Community Plan for Kids (CHIP) and UnitedHealthcare Medicare Advantage Insurance
Q. Why has WellSpan made the decision to no longer accept UnitedHealthcare AARP Medicare Advantage and UnitedHealthcare Group Medicare Advantage insurance?
A. As the region’s largest community-based non-profit health system, WellSpan is committed to keeping healthcare affordable for our patients and communities we serve by negotiating the appropriate contracts with payors. One of the ways we ensure affordability is by negotiating fair contracts with payors to ensure what we are reimbursed covers the cost of providing exceptional care.
Q. What UnitedHealthcare Medicare Advantage plans are impacted by this change?
A. This includes all UnitedHealthcare AARP Medicare Advantage and all UnitedHealthcare Group Medicare Advantage plans. This may also include UnitedHealthcare Dual Complete (DSNP) and UnitedHealthcare Nursing Home (ISNP) plans.
Q. I thought that WellSpan was already out of network with UnitedHealthcare Medicare Advantage – what’s changed?
A. WellSpan is currently participating with a portion of UnitedHealthcare Medicare Advantage plans as well as accepting UnitedHealthcare Group Medicare Advantage. Effective Nov. 1, 2024 – or Jan. 1, 2025, for patients with UnitedHealthcare Group Medicare Advantage or UnitedHealthcare Nursing Home (ISNP) plans – WellSpan has made the decision for these members to seek services from participating UnitedHealthcare providers.
Q. Can patients use their current UnitedHealthcare Community Plan for Kids (CHIP) insurance until November 1, 2024?
A. Yes, any covered services you receive prior to Nov. 1, 2024 will be submitted to your plan for payment.
Q. Can patients use their current UnitedHealthcare AARP Medicare Advantage insurance until November 1, 2024 (or January 1, 2025, for Group Medicare Advantage or Nursing Home (ISNP) plans)?
A. Yes, any covered services you receive prior to Nov. 1, 2024 – or Jan. 1, 2025, for UnitedHealthcare Group Medicare Advantage or UnitedHealthcare Nursing Home (ISNP) plans – will be submitted to your plan for payment.
Q. What other insurance plans does WellSpan accept?
A. At WellSpan, we accept other insurance plans which are listed on our website – WellSpan Health Plans; this page includes a number of insurance plan options with whom WellSpan participates for you to consider for you/your family.
Q. If a claim is not paid by the patients’ plan before Nov. 1, 2024 (or January 1, 2025, for Group Medicare Advantage), will they be responsible for the costs?
A. Services provided before Nov. 1, 2024 – or Jan. 1, 2025, for patients with UnitedHealthcare Group Medicare Advantage – will be submitted to your current insurance plan for payment. Only amounts which are not covered by your insurance carrier would need to be paid personally.
Q. Are patients able to continue to access emergency care?
A. Yes, we continue to welcome any patient needing emergency care services across our WellSpan Emergency Department locations.
Q. If patients have further concerns or questions about in network care options, who should they be referred to?
A. Please refer patients to contact their insurance plan, employer or nursing home facility, if applicable – to discuss questions and concerns about participating providers in their network.
Q. Will services scheduled after Nov. 1, 2024 – or January 1, 2025, for patients with UnitedHealthcare Group Medicare Advantage or Nursing Home (ISNP) plans – need to be cancelled?
A. For patients with UnitedHealthcare AARP Medicare Advantage, yes, services scheduled after Nov. 1, 2024 – or Jan. 1, 2025, for patients with UnitedHealthcare Group Medicare Advantage or UnitedHealthcare Nursing Home (ISNP) – will need to be redirected. Patients should work with their insurance plan to find a participating provider and location to reschedule any procedures or services.
Q. How can patients with UnitedHealthcare Community Plan for Kids (CHIP) insurance switch to another participating CHIP program?
A. In the event a contract agreement is not reached by Oct. 31, 2024, to continue to see your WellSpan physician and receive care at our facilities, you would be encouraged to switch your insurance plan to one that participates with WellSpan by calling Medicaid Enrollment at (800) 440-3989.
Q. Will WellSpan transfer my medical records if I have to select a new provider for services?
A. Requests for transfer of medical records can be made to the WellSpan Release of Information Department by completing the Authorization to Use or Disclose Health Information form available on wellspan.org. When on wellspan.org, enter 2606 in the search bar to locate the form – available in English, Spanish and Haitian Creole. Many components of your electronic health record are also available via our secure patient portal – MyWellSpan.
Q. Will WellSpan still be able to see me after Nov. 1, 2024 – or January 1, 2025, for patients with UnitedHealthcare Group Medicare Advantage – if I am in ongoing treatment?
A. Continuity of care under PA statute allows for patients to continue to be seen for ongoing treatment up to 60-days after a provider ceases to participate with a payor. Patients should be referred to their WellSpan provider involved with the patient’s care plan for application of continuity of care. Exceptions outside of this timeframe will need approval according to MAP 213.
