As deadline nears, UnitedHealthCare, Genesis still at odds

QC patients could become out-of-network on July 1

UnitedHealthCare Genesis MercyOne
Genesis Hospital West Campus, Tuesday November 9, 2021, in Davenport. CREDIT JOHN SCHULTZ

UnitedHealthcare is in contract negotiations that, if unresolved, would make Genesis and MercyOne health care providers out of network for most patients in the Quad Cities area beginning July 1.

According to statements and information released by the health care system and the global health benefits provider, the central issue is the size of the latest rate increases proposed during negotiations for a new contract. The contract is needed to replace the one set to expire in a little more than two weeks.

The parties have taken their dispute public and Genesis and MercyOne leaders are seeking the support of patients and employers in Iowa and western Illinois who are covered by UnitedHealthcare employer-sponsored and commercial health care plans, Medicare Advantage (individual and Group Retiree), and Dual Special Needs Program (D-SNP) health plans. 

Of the Genesis and MercyOne hospitals, facilities and physicians in the QC region, only the Genesis Medical Center in Aledo, Illinois (whose contract is independent of other Genesis entities) would remain in-network on July 1 if a new contract isn’t signed by the June 30, 2024, deadline. (MercyOne joined with the Genesis system in March.)

“We’ve dealt with UnitedHealthcare’s forceful negotiations and low rates for years because we didn’t want to go out of network and disrupt care,” Genesis and MercyOne said in a statement sent to the QCBJ on Tuesday, June 11. “The payment we receive from UnitedHealthcare does not appropriately cover the true cost of care we provide, especially given the cost inflation we have experienced, which is why we need a fair rate increase.”

‘Fair’ rate essential

That “fair” rate increase is essential, the statement said, because “Genesis Health System and MercyOne rely on fair payment to provide the care and services patients depend on and need. Unfortunately, UnitedHealthcare proposes increases far below the rates of other area-payer contract renewals. We are taking a stand now because we must — we can no longer sustain low reimbursement.”

UnitedHealthcare also shared the following statement today, June 12, when asked by the QCBJ for an update on negotiations:

“Michigan-based Trinity Health has issued notices to end several contracts for health systems it owns throughout the country, including MercyOne. We believe Trinity is taking these actions to leverage local communities by threatening to create widespread disruption in health care in order to drive up costs to benefit its national organization’s bottom line. We remain engaged in good-faith discussions with MercyOne and are actively exchanging proposals with the goal of reaching an agreement that is affordable and sustainable for Iowans and local employers.”

Additionally, in information UnitedHealthcare shared with its members (which can be found here) the benefits provider wrote: “We have a responsibility to provide the people we serve with access to quality health care while also helping to contain rapidly rising health care costs. Our goal is to keep MercyOne in our network at rates that are affordable for our members and employers throughout Iowa and western Illinois.”

The health care insurer added, “MercyOne is demanding significant price hikes for our employer-sponsored and Medicare Advantage health plans that would increase health care costs by $42 million over the next three years.”

The post added, “In an effort to compromise in the spirit of good-faith negotiation, we have provided MercyOne a proposal that includes meaningful rate increases.” 

That includes, UnitedHealthcare claims, “a double-digit commercial rate increase that would help ensure MercyOne continues to be reimbursed at market-competitive rates while helping to ensure health care remains affordable for the people and employers we serve throughout Iowa and western Illinois.”

Goal to ensure affordability

The insurer added “these demands would have a direct impact on the benefits and offerings we’re able to provide our Medicare Advantage members and would unnecessarily drive-up health costs.” 

UHC also said that in its latest contract offer it proposed reimbursing MercyOne at rates similar to other providers in its Medicare Advantage network throughout Iowa and Illinois.

Genesis and MercyOne disputed that claim in Tuesday’s statement, saying, “We are simply asking for fair rates that other payers have agreed to.”

The health care provider added: “Last year, UnitedHealth Group, the parent company of UnitedHealthcare, made record profits of more than $22 billion. UnitedHealthcare is making billions, frequently denying, delaying and underpaying claims and reimbursing at below-market rates while patients’ out-of-pocket costs continue to increase and not-for-profit providers like us struggle to invest in the medical innovations, technologies, and programs our communities depend on.” 

As a result, Genesis and MercyOne said, “We think it’s time UnitedHealthcare prioritized patients over their profits.” The health system also is encouraging “patients to call UnitedHealthcare or ask their employer to let UnitedHealthcare know that their health and access to the care they know and trust is important. Visit or call (563) 334-3010 for more details.

With contract negotiations coming down to the wire, UnitedHealthCare is telling members on its website: “We remain committed to working with MercyOne and are hopeful we can reach a resolution that maintains network access to its providers. But we also want to reassure our members that they will continue to have access to a robust network of hospitals and physicians should MercyOne leave our network.”

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