Lehigh Valley Health Network is poised to exit its network for UnitedHealthcare’s Medicare Advantage plans starting Monday, which could have significant implications for many patients. This change means that over 20,000 individuals who seek medical services at LVHN facilities might face interruptions in their healthcare if an agreement isn’t reached by then. Jefferson Health, which oversees the Lehigh Valley Health Network, announced on Wednesday that their two-year negotiations did not yield a new contract.
According to Jefferson, UnitedHealthcare has slashed payments to LVHN by almost 40% since 2021, leading to a staggering loss of revenue exceeding $100 million for the nonprofit health system over four years.
Jeffrey Price, a senior vice president at Jefferson involved with managed care and payer relations, expressed concern, stating, "When an insurer ceases to honor agreed-upon rates and avoids negotiations, it jeopardizes patient access to care. Jefferson and LVHN refuse to stand by while an insurer prioritizes its profit margins over fair agreements and sustainable healthcare."
For patients with UnitedHealthcare plans provided through their employers, they will continue to be considered in-network at LVHN facilities until around mid-April, according to Jefferson’s statement. However, this situation does not apply to patients in the Philadelphia area who are also insured by UnitedHealthcare, which is the largest health insurance provider in the United States.
Back in October, Jefferson first alerted the public about the potential for LVHN facilities to begin going out of network this month. At that time, UnitedHealthcare suggested that Jefferson's announcement during the Medicare Advantage annual enrollment period was merely a strategic move to exert pressure during negotiations.
As of Wednesday, there was no immediate response from UnitedHealthcare regarding this issue. If LVHN does indeed leave UnitedHealthcare’s network, it would be following in the footsteps of other prominent health systems like Johns Hopkins Medicine and Mayo Clinic, which have experienced similar disputes in the past year, although some specific group retiree plans may still remain in-network at Mayo Clinic.
In a related instance last March, Jefferson briefly went out-of-network with Cigna Health over a similar negotiation deadlock, but managed to quickly resolve the situation and forge a new deal shortly thereafter.
