Starting Wednesday, October 1, Ascension Wisconsin hospitals and providers will be out of network for patients enrolled in certain UnitedHealthcare insurance plans, as the two parties have failed to resolve a contract dispute.
This comes after months of negotiations. Multiple patients have reached out to TMJ4, concerned about the impact.
People enrolled in the following plans are affected:
- Employer-sponsored and individual commercial plans
- Medicare Advantage plans, including Group Retiree and Dual Special Needs Plans (DSNP)
- UnitedHealthcare Community Plans in Wisconsin (Medicaid)
Watch: Patients frustrated as Ascension WI and UnitedHealthcare fail to resolve contract dispute before deadline
Teresa Gutierrez was only 39 years old when she was initially diagnosed with breast cancer. She is grateful for the care team and for now being cancer-free. However, Gutierrez told TMJ4 that anxiety over potentially relapsing is only amplified while Ascension Wisconsin and UnitedHealthcare remain at odds over their contract.
"I'm a cancer survivor, so having regular check-ups is very important to me. I'm concerned about the lack of continuation of care," Gutierrez said.
Gutierrez held off on canceling her October appointments with Ascension Wisconsin in hopes she would not have to find a new provider.
"I was really comfortable with my team. They've been by my side for the last three years, and they know my name when I walk in. It's hard to know that I'm going to have to go through another provider," Gutierrez explained.
An Ascension Wisconsin spokesperson says UnitedHealthcare's proposals could reduce access and affordability.
They say: "We remain at the table and are ready to sign a fair contract, but we cannot – and will not – accept terms that we believe threaten the quality and sustainability of care in our community."
Dustin Hinton, UnitedHealthcare CEO in Wisconsin, says they proposed rate increases to reimburse Ascension at market-competitive rates and extend the current contract to continue discussions. Ascension refused.
Gutierrez, who serves as a mentor for others experiencing a breast cancer diagnosis, said it was important for her to show how this situation impacts people across the community.
"Honestly, I just want them to meet in the middle. I think that they need to look at the patients. I think they're making a big mistake by holding out, and they're just being selfish at this point," Gutierrez pressed.
Some patients in the middle of treatment may qualify for continuity of care, which provides in-network benefits for a certain period of time after a provider leaves the network.
It is unclear if and when the two sides will find a solution.
Visit this Ascension Wisconsin webpage for information. You can also stay up to date with UnitedHealthcare at this website.
See the Ascension Wisconsin's full statement below:
"Ascension Wisconsin continues to negotiate with UnitedHealthcare to ensure our patients with UnitedHealthcare coverage can remain in-network with our hospitals, clinics, and doctors.
Unfortunately, UnitedHealthcare — one of the largest and most profitable insurance companies in the country, reporting tens of billions of dollars in annual profits — is not offering reimbursement at what we believe to be fair, sustainable rates that reflect today’s dramatic financial realities facing health systems. In fact, UnitedHealthcare’s proposals represent a drastic shift from our current agreement – changes that we believe could reduce access and affordability and make it harder for many patients to get the care from the medical professionals who know them best.
We remain at the table and are ready to sign a fair contract, but we cannot – and will not – accept terms that we believe threaten the quality and sustainability of care in our community.
We strongly urge UnitedHealthcare to prioritize the health and welfare of their members and agree to fair terms that ensure continued access to the doctors and hospitals their members and employers trust."
See Dustin Hinton, UnitedHealthcare CEO, Wisconsin, here:
“Ascension Wisconsin continues to maintain its demands for unsustainable price hikes that would increase health care costs for consumers and employers. Our top priority is to reach an agreement that is affordable while providing continued, uninterrupted network access to Ascension’s hospitals and providers. We have proposed rate increases that would continue to reimburse Ascension at market-competitive rates while also requesting to extend our current contract to provide additional time to continue discussions. Ascension refused. We urge Ascension to work with us on solutions Wisconsin families and employers can afford.”
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