Baptist Health falls out of United network
Baptist Health’s hospitals, clinics and rehabilitation centers across Arkansas have been out of network with UnitedHealthcare insurance plans since Monday, as the two sides failed to reach a new contract.
Affected patients include those enrolled in UnitedHealthcare employer-sponsored and individual commercial plans, Medicare Advantage and Group Retiree plans, and Dual Special Needs Plans.
Baptist Health is Arkansas’ largest private nonprofit health care system, with facilities in Little Rock, North Little Rock, Conway, Fort Smith, Van Buren, Arkadelphia, Heber Springs, Hot Spring County and Stuttgart.
In a memo posted to its website and updated on Jan. 2, UnitedHealthcare said it has proposed “offering market-competitive rate increases” to ensure fair compensation for Baptist Health hospitals and physicians.
“We are disappointed that Baptist has continuously rejected these offers and is unwilling to acknowledge that its unreasonable rate request for a double-digit price hike would significantly drive up health care costs for the people we serve in Arkansas,” the statement read.
UnitedHealthcare’s current rates with Baptist Health are higher than the average rate the insurer pays out to other in-network Arkansas hospitals, the statement said, adding, “Agreeing to Baptist’s proposed rate increase will drive up premiums and out-of-pocket costs for our members, as well as the cost of doing business for both self-insured and fully insured companies, possibly impacting their ability to of
fer health care coverage for their employees.”
In an email a UnitedHealthcare spokesperson said, “Baptist Health is approximately 20% higher cost compared to other peer hospitals throughout the state, yet the health system proposed a one-year, 15% price hike and recently communicated to us it would also be seeking a double-digit rate increase in the second year of our contract. We have proposed a multi-year contract that includes meaningful rate increases that ensure Baptist is reimbursed at more than fair and reasonable rates. We ask that the health system either finalize the terms of our proposal or provide a reasonable proposal Arkansans and local employers can afford.”
Baptist Health spokeswoman Cara Wade said in an email that Baptist Health has been “open and transparent” with insurers for more than five years about the challenges it and other Arkansas hospitals face, including low reimbursement rates.
“The good news is we finalized agreements for 2024 with all but one of the larger payors in Arkansas. Unfortunately, United Healthcare has taken a different approach and is posting what Baptist Health believes is misleading and negative information that does little to address the undisputed reimbursement challenge that has developed over many years,” Wade said.
“United Healthcare has an offer on the table from Baptist Health that includes reimbursement rates that meet immediate needs, are still well below the national average, and are below what United Healthcare already pays to other hospitals in surrounding cities such as Texarkana, Texas; Springfield, Mo.; Shreveport; Monroe, La.; Tulsa; and Memphis.”
Baptist Health said in a Dec. 13 memo that Arkansas hospitals, per government and private studies, “have been identified as having the lowest reimbursement rates in the nation,” and that the inflationary surge has affected their costs of wages, supplies and pharmaceuticals.
“While Baptist Health continues to improve operational efficiencies and cost management, it is not enough to overcome the growing external cost pressures,” the memo said, further relaying that “mutually beneficial ways to move forward with most payors” have been negotiated.
The UnitedHealthcare memo said that nearly 80% of its Arkansas customers are insured in employer-sponsored plans, meaning their employers pay for their medical bills rather than UnitedHealthcare, linking Baptist Health’s proposed rate increase to self-funding employers’ operating budgets.
Information on the UnitedHealthcare website said affected customers “will be matched with a new in-network physician and medical group in their area,” noting that the more than 15,800 providers and nearly 110 hospitals in Arkansas are still in its network.
Those enrolled in UnitedHealthcare Medicare Advantage HMO, PPO and Group Retiree plans can continue going to Baptist Health if the provider is Medicare-approved and accepts the plan.
Some Baptist Health patients — such as those who are in the second or third trimester of pregnancy, those who have given birth in the past six weeks, patients with newly diagnosed or relapsed cancer and those in active cancer treatment — may qualify for a continuity-of-care provision.
The Baptist Health memo said such eligible patients with employer-covered insurance can seek care at its facilities for up to 90 days and, to their understanding, “most Medicare Advantage members (including Group Retiree plans) will continue to have access to Baptist Health.”
UnitedHealthcare patients with an emergency health issue should always go to the nearest hospital, as emergency services are covered in network regardless of whether the hospital is in or out of network.
“While we remain open to discussions with Baptist Health, our primary focus at this time is ensuring that the members we serve have uninterrupted access to the care they need through either continuity of care or supporting them as they transition to new care providers,” the memo said.
The development comes months after the Conway Regional Health System and UnitedHealthcare saw a summertime network lapse due to a contracting impasse, affecting up to 15,000 annual patients who had received hospital and clinical care.
The insurer said the health system was requesting a 65% price increase in a new contract’s first year, while Conway Regional officials said their below-market rates needed to increase, in part because of inflation-affected health care costs.
The two sides reached a contract six weeks later in August that includes a threeyear agreement for commercial plans. Conway Regional declined to discuss the terms.