Health insurance giant now says 5,000 Vermonters’ coverage at risk in contract dispute

Updated at 6:48 p.m.

In the nick of time, the University of Vermont Health Network has reached an agreement to continue accepting health insurance from thousands of Vermonters covered by UnitedHealthcare, the nation’s largest health insurer. 

The hospital network and the insurer had been at loggerheads over pricing, and UnitedHealthcare announced weeks ago that it would stop covering health care at the UVM Health Network on Friday. That included UVM Medical Center in Burlington, Central Vermont Medical Center in Berlin, Porter Medical Center in Middlebury, and three hospitals in northern New York state.

In a press release Tuesday afternoon, UVM Health Network said it has agreed with UnitedHealthcare to keep covering 2,900 subscribers in Vermont and northern New York who get coverage through their employers until March 31, 2023. At least 5,000 Vermonters would be impacted, state officials have said.

“We are happy to close this chapter and make sure we are meeting patient needs, regardless of their insurance carrier,” UVM Health Network CEO John Brumsted said in a statement. “(W)e need to cover the cost of providing care to remain sustainable. We were up against one of the biggest for-profit companies in the country, which nets $24 billion in profit annually. We regret the disruption and stress caused by this protracted Commercial negotiation.”

UnitedHealthcare, however, was more reserved in a statement released late Tuesday afternoon.

“We have agreed in principle to a new contract with UVM,” the insurance company said in its statement. “As we work to finalize the deal, both organizations have agreed to extend our existing contract through April 30, ensuring our members uninterrupted access to UVM’s facilities and its physicians. We hope to be ready to announce the final agreement soon.”  

Neither side was willing to offer details.

“UnitedHealthcare came closer to what we were asking for but did not fully meet it,” UVM Health Network spokesperson Annie Mackin told VTDigger.

Hundreds of Vermonters learned in a letter last month that UnitedHealthcare would stop covering their health care at UVM Health because the two sides could not agree on how much the insurer should reimburse the health provider for medical care. 

South Burlington resident Pallas Ziporyn, one of the patients left in limbo by the dispute, was pleased to learn of the resolution. 

“Obviously, that’s great news,” she said when VTDigger notified her of the resolution.

Ziporyn found out when she read an article in VTDigger that she was in danger of losing in-network coverage at UVM Health Network, where she expects to have a baby around April 16. She has to get prenatal care every week. She also has a thyroid condition being managed by an endocrinologist at UVM Health Network.

Ziporyn said that, as of Tuesday, she had still not received the letter from UnitedHealthcare that many patients had received. The letter warned that, as of April 1, the insurer would no longer include UVM Health Network within its network.

Ziporyn works remotely for Brigham and Women’s Hospital in Boston, which has contracted with Massachusetts-based Allways Health Partners to cover her in Vermont. Allways contracted with UnitedHealthcare to provide her coverage.

She called UnitedHealthcare to make sure that she would continue to receive care mandated by the federal No Surprises Act, which requires that insurers continue to insure people for 90 days after an insurance contract expires if, like Ziporyn, they are getting “continuing” care that has already commenced, such as cancer treatments or prenatal care. She said UnitedHealthcare told her to contact Allways.

She said Allways told her the company had not heard anything about the dispute between UnitedHealthcare and UVM Health Network, but would get in touch with United Healthcare and get back to her within 45 days. 

When Ziporyn pointed out that 45 days would be too late, she said the customer service representative told her: “We have thousands of members. You’re not the only one. Forty-five days is our process.”

A spokesperson for Allways did not respond to a request for comment. 

Burlington resident Dawn Moscowitz, another of the estimated 5,000 Vermonters caught in the dispute, said she was “thrilled” that the two sides reached an agreement. 

Moscowitz said the last few weeks have been “pretty overwhelming and nerve-wracking.” 

She said her family relies on UVM Health Network for its health care. She had worried about skyrocketing medical costs, should the health provider have found itself outside UnitedHealthcare’s network.

“We can’t quickly figure out alternative providers that are a reasonable distance,” she said.

Her husband has had cancer, she worried that her deductible would go up to $9,000 for any appointments at UVM Health Network, and UnitedHealthcare is the only plan her employer, an out-of-state nonprofit, offers.

Although she appreciates the one-year reprieve, she said she was “acutely aware that the contract expires in a non-open-enrollment window next year.”

Moscowitz said she is going to start talking to her employer about how to prevent being in this position a year from now. She will also look at the health plans offered on the state exchange Vermont Health Connect.