The HealthOne hospital system and UnitedHealthcare are locked in a dispute over rates, which could force patients to find new doctors if they can’t reach an agreement.
When a health system and an insurance company agree on rates, the system is “in-network,” meaning patients don’t pay as much out-of-pocket when they use its hospitals or clinics. If they can’t agree and the system goes “out-of-network,” patients have to choose whether to pay more to continue using the system, or to find new providers. Patients who have an emergency could still go to the nearest hospital, even if it is no longer in-network, without facing higher charges.
HealthOne’s contract with United Healthcare ends Sept. 1. If they don’t settle a contract or agree to an extension by then, patients insured by United would pay more to use:
• Centennial Hospital
• North Suburban Medical Center
• Presbyterian/St. Luke’s Medical Center
• Rocky Mountain Hospital for Children
• Rose Medical Center
• Sky Ridge Medical Center
• Swedish Medical Center
• The Medical Center of Aurora
United accused HealthOne of asking for an “unreasonable” double-digit increase in rates, which it said would drive up the cost of health insurance. It said customers could still use eight hospitals owned by other systems, as well as their affiliated clinics, if negotiations are unsuccessful.
HealthOne said United “mischaracterized” its position and was offering rates below what is typical in the Denver market. A statement from the health system said it intends to keep negotiating.
If HealthOne goes out-of-network, some patients could stay with their current doctors temporarily, including those who are pregnant and those who were just diagnosed with cancer or are undergoing treatment. Others would have to seek care from one of eight other hospitals that are in-network.
Health systems and insurers usually reach an agreement before their contracts expire, but CommonSpirit Health left Anthem BlueCross BlueShield of Colorado’s network for almost three weeks earlier this year while they continued bargaining over rates. UCHealth also went out-of-network with certain Anthem plans for one year in 2021.
Both sides of the current dispute are giants. United is the largest insurance company in the commercial and Medicare Advantage markets, while Tennessee-based HCA Healthcare, which owns the HealthOne hospitals, is the largest for-profit health system.
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Originally Published: August 14, 2024 at 12:45 p.m.
