Health system, insurance company dispute alters network

SPRINGDALE — A contractual dispute between Northwest Health and insurance company United-Healthcare means patients of dozens of area doctors could have to pay more or need to adjust their health care plan.

At least 96 doctors affiliated with Northwest in Benton and Washington counties have been considered out-of-network by United since Aug. 1 because the company and Northwest Health haven’t come to an agreement for how much United should pay for the system’s health care, according to the companies. Northwest pegged the total number of providers affected, including nurses and physicians’ assistants, at more than 200.

If the disagreement persists, Northwest said its hospitals, such as its medical centers in Springdale and Bentonville, will become out- of- network for United customers Nov. 1.

Both companies in statements blamed each other for the impasse and said they had offered to extend the contract but had been rebuffed. Both said negotiation continues.

“Patient care is our top priority, and we value our relationship with United, which is why we will continue to do all that we can to reach a resolution that restores our patients’ in-network benefits with their Northwest physicians,” Sharif Omar, Northwest CEO, said last month.

United said most of the members of the Northwest-affiliated independent practice association that includes the affected physicians have signed new contracts, leaving about 100 in the two-county area who haven’t.

Northwest didn’t provide a number of patients affected or the dispute’s impact on those patients’ costs, but out-of-network care typically means patients are responsible for more or all of the cost of a doctor’s appointment or

procedure instead of having much of it covered by their policy. Routine checkups with a family doctor can reach into the hundreds of dollars for multiple visits, according to United’s online cost estimator.

To avoid higher price tags, patients whose providers become out-of-network can choose other physicians. United advised its customers to contact the company by phone or go online to find in-network providers in the area.

Switching providers could mean losing provider relationships that can be years long, said Rachel Eikenberry, a Fayetteville mother of three whose United plan is provided through her employer, the University of Arkansas. Her family’s pediatrician, Dr. Susan Averitt in Springdale, is among the physicians affected.

All three children have seen Averitt their whole lives, Eikenberry said. Her oldest child is 7 and was recently diagnosed with a chronic condition. The family met the doctor during a health class when Eikenberry was first pregnant, and they soon set up an appointment with her.

“That’s turned out to be one of the best decisions we’ve ever made,” Eikenberry said, praising Averitt’s knowledge, attentiveness and support staff. Out-of-network care would likely be impossible for the family to afford, she added.

University spokesman Steve Voorhies said the university isn’t treating claims with the affected doctors any differently during the negotiation, and employees shouldn’t see a difference in their costs in the meantime.

“I hope it all works out,” Eikenberry said. “I hope that

both parties can take out the business aspect of it, because I know a lot of this is the business aspect. They’re talking about the bottom line, dollars and cents. I think they forget about the human element.”

Disputes such as this one aren’t uncommon as contracts get renewed on a regular basis — the University of Chicago’s health care system was part of at least two in the past two years, including one with United that resolved in June, according to the Chicago Tribune.

Patients also sometimes receive care from physicians who are out-of-network but work at a hospital that’s in-network. In cases such as these, patients can appeal their insurance company’s decision to withhold in-network benefits, based on reports from NPR and other outlets.

Cole Manbeck, a United spokesman, said patients undergoing

“active treatment” with an affected physician could be eligible for continued care, which temporarily keeps in- network benefits going. They had to apply by Aug. 31, however.

Northwest also urged patients to call United to check if they qualify for out-of-network benefits.

Insurance companies must inform patients within a few weeks when their health care provider leaves the company’s network, said Ryan James, a spokesman for the Arkansas Insurance Department. The state allows insurance companies to change their networks even between open enrollment periods but also monitors those networks to make sure they’re adequate to meet patients’ needs, he said.