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 insurance companies.
As we conclude our standard re-negotiation process with UnitedHealthcare (United), below are changes that will impact some of our patients and plans starting on Nov. 1, 2024.
- For patients covered under the UnitedHealthcare Medicaid Community Plan for Kids (CHIP), UnitedHealthcare Dual Complete (DSNP), and UnitedHealthcare Nursing Home (ISNP) Medicare Advantage insurance plans, we are pleased to share that WellSpan will continue to participate in United’s network. There will be no disruption in care for patients currently participating with these plans, and they can continue to receive services at WellSpan as usual.
- Despite WellSpan’s months-long efforts to reach a renewed agreement for patients with UnitedHealthcare Commercial PPO and HMO insurance, we were unable to find a mutually acceptable solution with UnitedHealthcare. As a result, effective Nov. 1, 2024, WellSpan Health will no longer be a participating provider for UnitedHealthcare Commercial PPO and HMO insurance plans.
- Starting Nov. 1, 2024, WellSpan no longer participates with any UnitedHealthcare AARP Medicare Advantage insurance plans.
- UnitedHealthcare Group Medicare Advantage members will continue to be able to see WellSpan providers for services through Dec. 31, 2024. Patients are encouraged to switch their insurance plan to one that participates with WellSpan during their employer’s Annual Open Enrollment. View a list of insurance plans with which WellSpan participates.
- For patients with UnitedHealthcare’s Medicare Supplement plans, which are secondary to traditional Medicare insurance coverage, these plans will continue to be accepted by WellSpan; they are not impacted by the Medicare Advantage plan changes occurring Nov. 1, 2024, or Jan. 1, 2025.
At WellSpan, our primary concern remains our thousands of patients who may no longer be able to afford what will become out of network costs associated with seeing their preferred WellSpan provider, hospital or renowned specialty care the system is known for across the region. United’s unwillingness to find a middle ground in negotiations will leave patients without affordable access to their provider of choice. WellSpan is the predominant healthcare provider available to most of these patients and to take away their ability to see their neighborhood doctor will be a severe blow to their care, not to mention general convenience.
As you are aware, WellSpan and other healthcare systems in PA and across the nation have experienced significant inflationary costs for staffing, drugs, and supplies of more than 18%, resulting in a significantly higher cost to deliver healthcare services to our community. 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 and yet our costs continue to align with that of healthcare facilities in the central Pennsylvania market.
We firmly believe United is unfairly comparing the costs of our services offered in central Pennsylvania to that of costs associated with care in other parts of the Commonwealth or country. Specific to WellSpan York Hospital, as the region’s sole Comprehensive Stroke Center and Level 1 Regional Resource Trauma Center, as well as the region’s largest Level 3 NICU, it cannot be appropriately compared to other local hospitals with considerably less acute care service offerings. And yet, WellSpan has already made significant concessions to accommodate United’s requests in the market, including parity adjustments that in some instances have resulted in rate reductions. Despite those concessions, United refuses to find middle ground.
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 insurance company that creates significant administrative burdens for our physicians and care teams with undue patient delays and denials of care which prevents timely treatment and recovery:
- They denied claims at rates higher than any other commercial insurance company. Our initial charges were denied 72% more often than average. The percentage of those charges that wound up being denied was also far higher than average.
- United audited WellSpan’s claims for patient care 2.8 times more often than other commercial insurance companies. Compared with the next-highest insurance company, their audit rate was 45% higher.
- United consistently delays timely payment for patient care. The money United owed WellSpan for services was about twice as high as the average of other insurance companies.
- They also had the worst rate for placement in other facilities after discharge. This resulted in delayed discharge for 225 WellSpan patients in the past year.
Unfortunately, United continues their campaign of attempting to misinform the public by selecting outlying data points to try and make their case. Meanwhile, they are currently using the same scare tactics, nearly word for word, in negotiations with a number of other health systems across the country. The growing number of organizations who are refusing to cave to United’s hardline negotiation tactics is expanding. We are proud to stand up for affordability in healthcare by making sure United does their fair share in offsetting the inflationary costs impacting the industry.
As a locally governed and locally based non-profit health system, our focus is on meeting the needs of our neighbors, and not the wants of a $371.6B for-profit organization whose commitments are only to their shareholders. That’s why embedded in our mission is improving the communities we call home, providing 50+ grants to organizations through our Community Grants Program in FY24 to create partnerships and pathways for all central Pennsylvania to thrive. We will not let the high-quality care we provide for our patients be undermined as simply an expense to United, who is only looking to line their deep pockets.
Regardless of in-network status, patients in need of emergency services may always go to a WellSpan Emergency Department, and United will be obliged to cover emergency room visits. And 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. We remain fully committed to minimizing any disruption in care and supporting our patients, providers, and employers throughout this process – while also ensuring continuity of care for patients whose care cannot be interrupted.
UnitedHealthcare patients with Commercial PPO insurance may choose to continue to receive care at WellSpan physician practices, imaging locations, and hospitals. Patients are being educated about potentially higher out-of-pocket costs because of WellSpan being an out-of-network provider 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.
We have provided additional notification to affected patients who received services from WellSpan in the past 18 months using UnitedHealthcare Commercial, Medicaid, or Medicare Advantage insurance plans about these changes. 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
Frequently Asked Questions – UnitedHealthcare Commercial HMO and PPO Insurance
Frequently Asked Questions – UnitedHealthcare Community Plan for Kids (CHIP) and UnitedHealthcare Medicare Advantage Insurance
