Carolinas HealthCare and UnitedHealthcare contract nears end

In the midst of negotiations over a new contract, UnitedHealthcare has notified its brokers that Carolinas HealthCare System “wants to be paid up to 150 percent more than other hospitals in the Charlotte area for providing the same services.”

The multiyear contract between Charlotte-based Carolinas HealthCare and the insurance company will expire Feb. 28 if a deal isn’t reached. That would leave 12 Charlotte-area hospitals and many doctors offices in Carolinas HealthCare “out-of-network” for the nearly 80,000 Charlotte-area members covered by UnitedHealthcare.

UnitedHealthcare notified brokers this week that negotiations have been underway since the fall, and the company remains “hopeful that the hospital system will decide to renew its participation in our network.” But the letter cited two areas of disagreement.

In the letter, UnitedHealthcare said Carolinas HealthCare has asked to be “paid about $5,300 more for a cardiac catheterization than what they’re paid today.”

UnitedHealthcare said it also has asked Carolinas HealthCare to base part of its reimbursement on achieving certain quality measures and patient outcomes, “but they are resistant.”

Spokeswoman Amy Murphy said Carolinas HealthCare is “not resistant. We are completely willing to talk about being paid for quality.” As for UnitedHealthcare’s claim that Carolinas HealthCare wants higher payments than other hospitals, Murphy said: “We cannot know what UHC agrees to pay other providers, so I don’t know that to be true.” She added that Carolinas HealthCare patients benefit from an integrated system that provides high-quality care and access to specialty services that aren’t offered elsewhere.

It’s not unusual for hospital and insurance company negotiations to become strained, but contracts are typically worked out at the final hour.

If the contract with Carolinas HealthCare were to expire, UnitedHealthcare spokeswoman Tracey Lempner said members with Medicare supplement plans would not be affected, because they are allowed to go to any doctor. Medicare Advantage participants would be affected, because they would become out-of-network.

UnitedHealthcare has had a contract with Carolinas HealthCare for more than a decade. Last year, it renewed a contract with Novant Health, the Winston-Salem-based company that owns four hospitals in Mecklenburg County.

This story was originally published January 27, 2015 at 6:49 PM with the headline "Carolinas HealthCare and UnitedHealthcare contract nears end."