Contract talks stall for some health plans - Albuquerque Journal

Contract talks stall for some health plans

Lovelace Hospital in Albuquerque. Physician and hospital contracts between UnitedHealthcare and Lovelace are set to expire early next year, potentially affecting care for thousands of patients. (Chancey Bush/Albuquerque Journal)

Copyright © 2022 Albuquerque Journal

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

Aycock, like many other New Mexicans, was on UnitedHealthcare’s Medicare Advantage plan. Lovelace, during those years, has been a main source of care for Aycock – from her primary care provider to critical treatments.

But, heading to Lovelace may come to an end for Aycock and other United members as physician and hospital contracts between UnitedHealthcare and Lovelace are set to expire early next year, affecting thousands of patients and leaving many United members worried they may lose access to critical care. Negotiations, for now, remain stalled and it isn’t clear if new contract agreements will be reached before they are set to expire.

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

The current contract between United and Lovelace’s hospitals is set to expire in January. And the contract between United and Lovelace’s physicians will come to a close in March if a new agreement is not made, according to an emailed statement provided by United spokeswoman Catherine Farrell.

The end of these contracts means, starting next year, all United plans – with the exception of Medicare Supplement plans, often referred to as secondary insurance plans – will be considered out of network.

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

“We want to keep Lovelace in our network, but, if we’re unable to reach an agreement, our members will continue to have access to a broad network of hospitals and physicians in New Mexico, including UNM and Presbyterian,” United said. “We hope Lovelace works with us to reach an agreement that’s affordable for the New Mexico residents we collectively serve.”

Marquez called the stalled negotiations, and the lack of new contracts between the health system and insurer, a “disservice to United members,” adding that “United has never offered Lovelace any proposal for consideration.”

Marquez said the changes to contracts between United and Lovelace will not affect the Lovelace UNM Rehabilitation Hospital, helping keep United members in network at that facility. Emergency services will also not be impacted at Lovelace “as all insurance plans are required to cover those services as in network.”

United said if 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 the Lovelace Regional Hospital in Roswell will be out of network for United plans on Jan. 15 if no agreement is reached.

Starting on March 1, providers at Lovelace will also be out of network for commercial, employer-sponsored, individual, Medicare Advantage and Group retiree plans.

Aycock recently was able to find a new insurer to stay within the Lovelace health system. But she said the stalled negotiations have major implications for patients such as her. “It’s desperation,” she said. “It’s like the rug is yanked out from underneath you.”

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