Contract negotiations stall for some health plans

Lovelace Hospital in Albuquerque, NM, on Friday, November 25, 2022. (Chancey Bush/Albuquerque Journal)

Copyright © 2022 Albuquerque Journal

Albuquerque resident Colleen Aycock has been battling aggressive cancer for the past two years.

Aycock, like many other New Mexicans, was in UnitedHealthcare’s Medicare Advantage plan. During those years, Lovelace was Aycock’s main source of care, from her primary care provider to critical treatments.

But the referral to Lovelace could end for Aycock and other United members as the physician and hospital contracts between UnitedHealthcare and Lovelace expire early next year, affecting thousands of patients and leaving many United members worried they could lose access to critical care. For now, negotiations remain at a standstill and it is unclear whether new contractual agreements will be reached before they expire.

“To me, this is a crisis,” Aycock told the Journal. “We can’t get answers.”

The current contract between United Hospital and Lovelace expires in January. And the contract between United and Lovelace’s doctors will end in March unless a new agreement is reached, according to an emailed statement provided by United spokeswoman Catherine Farrell.

The end of those contracts means that starting next year, all United plans — except Medicare supplement plans, often called secondary insurance plans — will be considered out-of-network.

The possible end of those agreements, which have been in place for nearly 20 years, would affect up to 13,400 United members, said Whitney Marquez, a Lovelace spokeswoman. That includes about 9,700 Medicare Advantage plan members, including 2,400 United members, who have Lovelace doctors as their primary care providers.

“We want to keep Lovelace in our network, but if we can’t reach an agreement, our members will continue to have access to a broad network of hospitals and doctors in New Mexico, including UNM and Presbyterian,” United said. “We hope Lovelace works with us to reach an agreement that is affordable for the New Mexico residents we collectively serve.”

Marquez called stalled negotiations and the lack of new contracts between the health system and the insurer “a disservice to United’s members,” adding that “United never offered Lovelace any offer to consider.”

Marquez said the contract changes between United and Lovelace will not affect Lovelace UNM Rehabilitation Hospital, helping United members stay in-network at that facility. Urgent services also won’t be affected at Lovelace, “as all insurance plans are required to cover these services as in-network.”

United said that if the new contracts are not renegotiated, Lovelace Medical Center, Heart Hospital of New Mexico at Lovelace Medical Center, Lovelace Women’s Hospital and Lovelace Westside Hospital will be out of network for Medicare Advantage and Group Retiree plans on Jan. 1.

The New Mexico Heart Institute on Jan. 1 will also be out of network for employer-sponsored and individual plans, and Lovelace Regional Hospital in Roswell will be out of network for United plans on Jan. 15 if no agreement is reached.

Beginning March 1, Lovelace providers will also be out-of-network for commercial, employer-sponsored, individual plans, Medicare Advantage and retiree group plans.

Aycock was recently able to find a new insurer to remain with Lovelace Health System. But she said the stalled negotiations have big implications for patients like her. “It’s desperation,” she said. “It’s like the rug has been pulled out from under you.”

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