Network based systems

Dispute between UnitedHealthcare and UVM Health Network could leave 2,900 patients seeking care

Eliza Graves at her home in Jericho on Friday, March 4. Graves is about to start chemotherapy at UVM Medical Center for a rare and aggressive form of cancer, but she is worried about starting treatment because she said UnitedHealthcare told her it would only cover about 30 days. chemotherapy. Photo by Glenn Russell/VTDigger

Some 2,900 patients covered by UnitedHealthcare may no longer be able to see providers at the University of Vermont Medical Center and its connected hospitals, as the nation’s largest insurer and Vermont’s largest health network no longer were unable to conclude a contract.

If the stalemate persists, hundreds of patients would be sent scrambling to find providers in an area with fewer and fewer options – and in some cases no nearby alternatives for the specialists they need.

Among them is Eliza Graves, 34, of Jericho, who is about to start chemotherapy at UVM Medical Center for a rare and aggressive form of cancer. Now, she says, she’s worried about starting treatment because she said UnitedHealthcare told her it would only cover about 30 days of chemotherapy.

“It’s life or death for me,” Graves said. “It’s criminal. It looks like a hostage situation, and they certainly don’t seem to care at all about the people they affect.

A Feb. 23 letter distributed by UnitedHealthcare to its customers warned them that University of Vermont Health Network coverage may end for patients with employer and individual plans beginning April 1.

“We are working hard to expand their participation to keep them connected for our employer and individual health care plans,” the letter said.

Medicare Advantage, Medicare Supplemental Insurance and Vermont Veterans would not be affected, UnitedHealthcare said.

UVM said it would continue to accept UnitedHealthcare insurance for home care and hospice patients.

The Feb. 23 letter tells customers that if UnitedHealthcare fails to reach an agreement with the University of Vermont Health Network, patients would lose coverage at the University of Vermont Medical Center, Central Vermont Medical Center in Berlin, at Porter Medical Center in Middlebury and three hospitals. in New York: Alice Hyde Medical Center, Champlain Valley Physicians Hospital Medical Center and Elizabethtown Community Hospital.

And if patients seek care outside of the UnitedHealthcare network, he warns, their costs will increase or they may have to pay the full cost of medical care.

The letter recommends clients transfer their care to Copley Hospital in Morrisville, Gifford Medical Center in Randolph or Northwestern Medical Center in St. Albans, or one of two New York hospitals: Adirondack Medical Center or Canton Potsdam Hospital .

The letter reassures customers that they can still get emergency care at any hospital.

The insurer advises customers that they may be able to continue to receive care at the University of Vermont Medical Center and affiliated hospitals for a short time if they are pregnant, actively receiving treatment for an illness, or receive treatment such as chemotherapy.

Most of the 2,900 patients who UnitedHealthcare estimates would be affected live in Vermont, including some in New York. He could not provide exact figures.

UnitedHealthcare cited UVM’s high costs—which it attributes to UVM’s market dominance—for its decision to let its contract with UVM expire. UnitedHealthcare said UVM was seeking a nearly 10% rate increase for fiscal year 2022. The insurer said the cost of care at UVM for its members in employer and individual plans had increased 15% since 2020.

“Rapidly accelerating costs at the University of Vermont Health Network are neither affordable nor sustainable for residents and employers in Vermont and northern New York,” UnitedHealthcare said in a statement.

“Our top priority is to renew our relationship with the healthcare system so that our members have continued access to affordable quality care. We hope that the University of Vermont (Health Network) shares the same commitment and will work with us to ensure that the people and employers we mutually serve have continued access to healthcare without disruption,” he said. .

UVM Health Network officials – who said it was their decision not to renew the contract – attribute the rising costs to increased staffing, supply and pharmaceutical costs.

“Our network continues to be one of the least expensive in the country, but we must cover our costs to provide timely access to quality care,” the health network said in a statement.

The health network also criticized administrative obstacles at UnitedHealthcare.

“For a number of years, our ability to provide timely and appropriate care to patients covered by UnitedHealthcare Commercial Insurance, a for-profit national insurance company, has been hampered by their administrative and operational requirements,” said officials. officials in the press release.

“Despite our best efforts to address these issues, patients continue to experience unnecessary delays and restrictions on approvals for common tests, imaging, treatments and medications, among other challenges, due to the company’s own policies and practices. refund from United,” according to the statement.

As an example, UVM said a policy that went into effect last fall bars the medical center and its affiliates from scheduling colonoscopies for UnitedHealthcare patients.

UnitedHealthcare is a subsidiary of Minnesota-based UnitedHealth Group Inc., an integrated healthcare company that also includes Optum Health, an extensive national network of healthcare providers; OptumRx, a large pharmacy benefit manager; and OptumInsight, a health technology company. UnitedHealth Group’s revenue in 2021 was $288 billion.

Eliza Graves at her home in Jericho on Friday, March 4. Photo by Glenn Russell/VTDigger

“I am completely devastated”

Graves, the Jericho resident, was recently diagnosed with pancreatic angiosarcoma, one of the rarest cancers. She said five tumors surround her pancreas.

“I’m just starting my treatments hoping to do anything to prolong my life,” Graves said. “It’s a very aggressive cancer, just terrible.”

Most doctors in Graves are at UVM Medical Center.

“I’m absolutely devastated,” Graves said. “It affects me greatly.”

She moved back to Vermont two years ago to be near her mother, who had early-stage Alzheimer’s disease, and it took her a long time, she said, to be able to see all the doctors she needed for her complex medical case, even before she was diagnosed with cancer. She suffers from asthma and Ehlers-Danlos syndrome, an inherited connective tissue disorder that causes her joints to dislocate easily.

“With the Covid, there are so many delays. It’s so hard to go anywhere with a doctor,” Graves said. “The only doctors available are at UVM, and they all have huge waiting lists.”

She injured her ankle again in July and had to wait until January to be scheduled for surgery which led to the discovery of her cancer. Because of her asthma and Ehlers-Danlos, she said, her pulmonologist and allergist recommended a CT scan of her lungs before surgery to make sure she wouldn’t have any issues with anesthesia. It was then that the mass on his pancreas was discovered.

After several delays, she was officially diagnosed on February 17, she said. Her cancer is so rare that UVM referred her to the Dana Farber Cancer Institute in Boston, where doctors direct her care and are covered by United Healthcare. Her oncology team Dana Farber recommended that she undergo chemotherapy as close to home as possible, at UVM.

“Dana Farber has been excellent and they’re amazed this is happening,” Graves said.

Her first oncology appointment is supposed to be at UVM Medical Center on Tuesday, but to stay covered by UnitedHealthcare, she must now travel to Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, 95 miles away.

“I don’t want to drive an hour and a half each way with a broken ankle while on chemo sick as a dog,” Graves said. “I just don’t understand how this can be allowed and how everyone is okay with this and how UVM can see themselves as pillars of the community and not care that so many of us don’t have other options. It’s not like there are other hospitals nearby that are equal to UVM, not at all.

She can’t switch insurance plans because her husband’s job only offers UnitedHealthcare and Kaiser Permanente, which don’t cover providers in Vermont.

“I’m terrified,” Graves said. “I can’t wait to start treatment.”

She said she’s not sure if she should keep her Tuesday appointment at UVM because she can’t afford to go somewhere out of the network for chemotherapy.

“I can’t waste time trying to transition through all of this and miss life-saving chemo when it’s increasing dramatically each week,” Graves said. “I left to dry off, and I can’t believe it.”

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