Thousands insured by UnitedHealthcare now out of network with Conway Regional over billing impasse

Patients sent out of network

UnitedHealthcare cards and forms are shown in this June 15, 2018 file photo. (AP/Wilfredo Lee)

The Conway Regional Health System did not accept a new contract from UnitedHealthcare governing the insurer's payouts for the hospital's care on June 30, causing the hospital to go out-of-network the next day.

Both sides say they are open to negotiations that could yield a mutually acceptable contract, but Conway Regional Chief Executive Officer Matt Troup said no dates for meetings with UnitedHealthcare are scheduled.

Some 15,000 UnitedHealthcare-insured patients received care at Conway Regional in the past year. More than 250 Conway Regional physicians and other providers are now out-of-network with UnitedHealthcare insurance. Troup said the impasse may result in a 10% loss in the hospital's revenue.

"Conway Regional Health System is demanding to double the cost of care at its hospitals over the next 24 months, including an egregious 65% price hike in just the first year of our contract," said a UnitedHealthcare spokesperson in a statement, characterizing the June 30 contract as "signature-ready" and one "that included significant rate increases that were more than fair and appropriate."

"Rather than sign the contract or provide a counter proposal, Conway Regional chose to allow our agreement to expire. While we remain open to continued negotiation should the health system deliver a realistic proposal that's affordable, our focus now is on ensuring the people we serve have access to the care they need through either continuity of care or a smooth transition to a new provider."

Troup said UnitedHealthcare gave insufficient time for his team to parse their contract on June 30. He did not confirm whether Conway Regional is asking for a 65% increase in UnitedHealthcare's payouts, saying, "We need to do our own due diligence before I could get to the point of saying what percent-increase it is. I know it's an increase, but we have to go through our modeling to assess that." He said the 65% figure contains in-patient and out-patient rates and provisions for patients who are hospitalized for extended periods of time.

Troup said staffing levels will "flex" akin to their rise and fall during and after flu season absent insurance payments and co-pays. Long term, he noted that some employers, those who buy insurance through the state's marketplace and Medicare Advantage customers will choose non-UnitedHealthcare plans, saying such actions will blunt the loss of revenue.

Conway Regional going out-of-network with UnitedHealthcare is not a qualifying life event under the Affordable Care Act, therefore those who have UnitedHealthcare now will not be able to move to a different coverage plan. Affected retired state public sector workers enrolled in UnitedHealthcare's ARBenefits Medicare Advantage Group PPO, however, have until Tuesday to change plans.

Troup said there is "philosophical agreement" that Conway Regional's rates with UnitedHealthcare are below-market and need to increase, saying now-lapsed payout rates for his system are out-of-sync with competitors in the area because of other hospitals having contracted with UnitedHealthcare at different times. He said that the rates Conway Regional had contracted with UnitedHealthcare years ago no longer reflect inflation-affected health care costs.

UnitedHealthcare, however, said Conway Regional's proposals would tremendously increase employers' health care costs. The spokesperson says the hospital's claims about reimbursement do not include factors like services provided, care quality and cost into account.

The spokesperson also said that people enrolled in the UnitedHealthcare Group Retiree PPO plan can still receive care through Conway Regional if they see a Medicare-approved provider who accepts the plan and that UnitedHealthcare insurance remains accepted at Baptist Health, St. Vincent and University of Arkansas for Medical Sciences facilities.

Those with UnitedHealthcare insurance who are in the middle of treatment at Conway Regional, like pregnant or in-treatment cancer patients, may qualify for continuity of care for a period of time.

Troup said he is "grieved" by the number of community members who are losing in-network access to Conway Regional.

"Unfortunately, the state of health care being what it is, something has to give. And every datapoint that we look at tells us United's rates are way below market," he said. "I'm not doing the team that comes and sacrifices so much here every day to serve our patients and community justice by tolerating some sub-market rate, rates that they pay other hospitals in Central Arkansas."