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UnitedHealthcare, Envision, settle contract dispute

Contract extension avoids out-of-network surprise bills for UnitedHealth beneficiaries using emergency room services staffed by Envision physicians.

Susan Morse, Senior Editor

UnitedHealthcare and Envision Healthcare have agreed to a contract extension, ending a longstanding dispute over ER payment rates.

The agreement, announced yesterday, ensures that all UnitedHealthcare plan participants will have in-network access to Envision's 25,000 clinicians, including emergency room physicians.

The terms of the agreement were not announced. 

WHY THIS MATTERS

Envision physicians would have been out-of-network for UnitedHealthcare plan participants as of January 1, 2019, putting these patients at risk for surprise medical bills.

America's Health Insurance Plans and other healthcare organizations this week urged Congress for legislative action to prevent surprise billing.

BACKGROUND

The contract dispute centered on payment rates.

UnitedHealthcare said Envision charged patients at rates three times higher than what it should have levied. Envision said this was due to out-of-network charges because the insurer refused to bring Envision provider groups into their contract agreement.

Envision said there were never any problems until UnitedHealth demanded massive cuts to allow it to stay in-network. UnitedHealthcare said it offered Envision competitive rates for all of their hospital-based services, similar to what other ER and hospital-based physicians are paid in other markets.

In May, a court ordered arbitration between the insurer and network provider after dismissing a lawsuit brought by Envision claiming UnitedHealthcare changed its payment rate agreement.

In September, UnitedHealthcare sent out an advanced notice to more than 700 hospitals that Envision, its emergency room contractor, could be out of network starting in January.

ON THE RECORD

"We are pleased to continue our long-term relationship with UnitedHealthcare by successfully extending our agreement to ensure patients have in-network access to Envision Healthcare hospital-based clinicians," said Christopher A. Holden, CEO and president of Envision Healthcare.

UnitedHealthcare said, "This agreement ensures the people we serve have continued access to Envision's hospital-based services while delivering better value to our customers and consumers."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com