Lehigh Valley Health Network will go out of network for UnitedHealthcare’s Medicare Advantage plans Monday
The failure of LVHN and UnitedHealthcare to reach a contract will affect more than 20,000 Medicare Advantage patients, Jefferson said.
Jefferson Health’s Lehigh Valley Health Network will go out of network Monday for members of UnitedHealthcare’s Medicare Advantage plans.
That means about more than 20,000 people who get care at LVHN facilities could experience disruptions in their care. Two years of negotiations failed to result in a new contract, Jefferson said in a statement Wednesday.
Jefferson also said that United reduced payments to LVHN by nearly 40% since 2021, reducing the nonprofit health system’s revenue by more than $100 million over four years.
“When an insurer stops paying agreed‑upon rates and refuses to negotiate, patient access is put at risk. Jefferson and LVHN will not stand by while an insurer prioritizes its own margins over fair contracts and sustainable care,” said Jeffrey Price, a Jefferson senior vice president involved in managed care and payer relations.
LVHN patients who have UnitedHealthcare plans through their employers will remain in-network at the nonprofit system through most of April 25, Jefferson said.
United said that negotiations continue on those contracts, but noted that LVHN wanted a 20% price increase in the first year.
The dispute does not affect Philadelphia-area Jefferson patients with insurance from UnitedHealthcare, the nation’s largest health insurer.
Jefferson first warned in October that its LVHN facilities would start going out of network this month.
At the time, United suggested that Jefferson’s announcement during the Medicare Advantage annual enrollment period was a negotiating tactic designed to put pressure on United.
United said Wednesday that its “top priority is providing people continued access to the care they need through our broad network of providers who collaborate with us to provide quality, affordable care.”
The company noted that it recently signed a multiyear contract with LVHN’s biggest competitor, St. Luke’s University Health Network. That contract covers employer-sponsored plans as well as Medicare and Medicaid plans.
By going out of network with United Medicare Advantage plans, LVHN joins other well-known systems to have done so in the last year. They include Johns Hopkins Medicine and Mayo Clinic.
Last March, Jefferson went out of network with Cigna Health for a few weeks during a similar impasse in negotiations. Jefferson and Cigna quickly reached a deal after the termination.